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NPI Code Detail

MEDICARE: JACQUELYN CELENE AVALOS

MEDICARE: JACQUELYN CELENE AVALOS
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
1390200000XStudent in an Organized Health Care Education/Training Program
2106S00000XBehavior Technician

General Provider Information

NPI Number : 1124689310
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELYN CELENE AVALOS
Provider Business Mailing Address
First Line : 2601 E YANDELL DR STE 118
Second Line :
City : EL PASO
State : TX
Zip : 79903-3743
Country : US
Telephone Number : 915-588-4928
Fax Number :
Provider Business Practice Location Address
First Line : 2601 E YANDELL DR STE 118
Second Line :
City : EL PASO
State : TX
Zip : 79903-3743
Country : US
Telephone Number : 915-588-4928
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2019
Last Update Date : 04/28/2025

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Directions to “ JACQUELYN CELENE AVALOS ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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