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General NPI Number Information
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NPI Number | 1922694710
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Entity Type | Organization
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Legal Business Name | AVALA PHYSICIAN NETWORK, LLC
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Dates
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Enumeration Date | 12/15/2020
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Last Update Date | 10/23/2025
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Provider Practice Location Address
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Address Line | 1200 PINNACLE PKWY STE 3
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City | COVINGTON
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State | LA
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Zip | 70433-9169
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Country | US
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Telephone | 985-674-1700
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Fax |
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Provider Business Mailing Address
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Address Line | 67252 INDUSTRY LN
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City | COVINGTON
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State | LA
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Zip | 70433-8704
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Country | US
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Telephone | 985-888-1182
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | BROOKE CUMMINGS
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Credential |
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Telephone | 985-801-6247
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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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 | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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