=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659574515
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARISOL TATIANA AVILA A.R.N.P-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2007
-----------------------------------------------------
Last Update Date | 02/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1311 E THOMAS RD
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85014-5707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-322-1315
-----------------------------------------------------
Fax | 602-889-7392
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1311 E THOMAS RD
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85014-5707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-322-1315
-----------------------------------------------------
Fax | 602-889-7392
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | RN135266
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | AP2288
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------