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General NPI Number Information
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NPI Number | 1700118726
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Entity Type | Individual
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Provider Name | HECTOR AVILA MADRIL JR. M.A.
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Gender | Male
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Dates
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Enumeration Date | 02/01/2010
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Last Update Date | 01/21/2017
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Provider Practice Location Address
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Address Line | 2001 S BARRINGTON AVE SUITE 203
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City | LOS ANGELES
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State | CA
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Zip | 90025-5363
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Country | US
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Telephone | 310-985-4863
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 641112
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City | LOS ANGELES
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State | CA
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Zip | 90064-6112
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Country | US
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Telephone | 310-985-4863
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 84743
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License Number State | CA
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