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General NPI Number Information
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NPI Number | 1841431392
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Entity Type | Individual
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Provider Name | JORGE AVALOS PA
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Gender | Male
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Dates
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Enumeration Date | 03/12/2009
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Last Update Date | 01/14/2026
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Provider Practice Location Address
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Address Line | UNIT 5210, BOX 230
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City | APO
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State | AE
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Zip | 09461
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Country | US
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Telephone | 440-163-8525
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Fax |
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Provider Business Mailing Address
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Address Line | UNIT 5210, BOX 230
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City | APO
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State | AE
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Zip | 09461-5210
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Country | US
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Telephone | 440-163-8525
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 52192
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License Number State | CA
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