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NPI Code Detail

MEDICARE: ROBERTO AVILA MPSS-BLAMRD

MEDICARE: ROBERTO AVILA MPSS-BLAMRD
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
1175T00000XPeer SpecialistMPSS-BLAMRDCA
2171M00000XCase Manager/Care Coordinator20515CA

General Provider Information

NPI Number : 1770472821
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERTO AVILA MPSS-BLAMRD
Provider Business Mailing Address
First Line : 2226 MANZANA WAY
Second Line :
City : SAN DIEGO
State : CA
Zip : 92139-4027
Country : US
Telephone Number : 442-236-7956
Fax Number :
Provider Business Practice Location Address
First Line : 336 OXFORD ST STE 209
Second Line :
City : CHULA VISTA
State : CA
Zip : 91911-3122
Country : US
Telephone Number : 619-691-1662
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/02/2025
Last Update Date : 03/30/2026

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Directions to “ ROBERTO AVILA MPSS-BLAMRD” Practice Location

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