MEDICARE: RODRIGO MAGNO AVERILLA JR.

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	373H00000X	Day Training/Habilitation Specialist

General Provider Information

NPI Number	:	1528935426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RODRIGO MAGNO AVERILLA JR.

Provider Business Mailing Address
First Line	:	1633 NEWCOMB AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94124-2318
Country	:	US
Telephone Number	:	415-654-0567
Fax Number	:	415-654-0567

Provider Business Practice Location Address
First Line	:	1018 MISSION ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94103-2813
Country	:	US
Telephone Number	:	415-361-4950
Fax Number	:

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

Provider Enumeration Date	:	10/23/2025
Last Update Date	:	10/23/2025

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