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NPI Code Detail

MEDICARE: PABLO AVILA

MEDICARE: PABLO AVILA
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
1101YA0400XAddiction (Substance Use Disorder) Counselor
2101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1174242507
Entity Type Code : Individual
Provider Name (Legal Business Name) : PABLO AVILA
Provider Business Mailing Address
First Line : 5900 GORDON AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89108-2476
Country : US
Telephone Number : 702-324-0315
Fax Number :
Provider Business Practice Location Address
First Line : 1509 S EASTERN AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89104-3916
Country : US
Telephone Number : 702-324-0315
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2022
Last Update Date : 08/29/2022

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Directions to “ PABLO AVILA ” Practice Location

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