MEDICARE: CAMILA AVILA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME129513	FL
2	207R00000X	Internal Medicine Physician	129513	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063899615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMILA AVILA M.D.

Provider Business Mailing Address
First Line	:	6107 MEMORIAL HWY STE A
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-4564
Country	:	US
Telephone Number	:	813-514-2328
Fax Number	:	813-514-2485

Provider Business Practice Location Address
First Line	:	6107 MEMORIAL HWY STE A
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-4564
Country	:	US
Telephone Number	:	813-514-2328
Fax Number	:	813-514-2485

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2015
Last Update Date	:	06/05/2022

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