MEDICARE: MR. JORGE AVALOS PA

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1841431392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JORGE AVALOS PA

Provider Business Mailing Address
First Line	:	PSC 482
Second Line	:	BOX 3057
City	:	FPO
State	:	AP
Zip	:	96362-9998
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	PSC 482
Second Line	:	US NAVAL HOSPITAL OKINAWA
City	:	FPO
State	:	AP
Zip	:	96362-9998
Country	:	US
Telephone Number	:	011816117437555
Fax Number	:

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

Provider Enumeration Date	:	03/12/2009
Last Update Date	:	03/12/2009

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Directions to “ MR. JORGE AVALOS PA” Practice Location

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