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General NPI Number Information
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NPI Number | 1487917761
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Entity Type | Individual
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Provider Name | LINDA CECILIA AVILA LVN
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Gender | Female
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Dates
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Enumeration Date | 06/21/2012
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Last Update Date | 06/21/2012
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Provider Practice Location Address
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Address Line | 1601 LAKE ST
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City | LODI
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State | CA
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Zip | 95242-2436
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Country | US
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Telephone | 209-601-4628
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Fax |
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Provider Business Mailing Address
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Address Line | 2606 BELVEDERE AVE
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City | STOCKTON
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State | CA
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Zip | 95205-3255
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Country | US
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Telephone | 209-298-8262
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 266076
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License Number State | CA
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