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General NPI Number Information
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NPI Number | 1710546585
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Entity Type | Individual
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Provider Name | ANDREA PEREZ AVINA MA, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 06/06/2019
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Last Update Date | 07/08/2020
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Provider Practice Location Address
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Address Line | 501 JESSIE AVE
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City | SACRAMENTO
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State | CA
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Zip | 95838-2608
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Country | US
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Telephone | 916-922-8855
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Fax | 916-922-6208
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Provider Business Mailing Address
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Address Line | 115 GARRY CT
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City | ARBUCKLE
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State | CA
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Zip | 95912-9569
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Country | US
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Telephone | 530-723-3972
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 30083
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License Number State | CA
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