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NPI Code Detail

MEDICARE: MOLLY RYDAN AVILA

MEDICARE: MOLLY RYDAN 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
1106S00000XBehavior Technician106S00000XTX

General Provider Information

NPI Number : 1417803982
Entity Type Code : Individual
Provider Name (Legal Business Name) : MOLLY RYDAN AVILA
Provider Business Mailing Address
First Line : 4541 N BENTWOOD DR
Second Line :
City : SAN ANGELO
State : TX
Zip : 76904-8229
Country : US
Telephone Number : 325-212-8100
Fax Number :
Provider Business Practice Location Address
First Line : 4541 N BENTWOOD DR
Second Line :
City : SAN ANGELO
State : TX
Zip : 76904-8229
Country : US
Telephone Number : 325-212-8100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2026
Last Update Date : 03/07/2026

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Directions to “ MOLLY RYDAN AVILA ” Practice Location

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