Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1043643752 |
---|---|
Provider Name | Anthony Avila-Martin |
First Address | Minden, NV 89423-8985 |
Second Address | Yerington, NV 89447-8722 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2013 |
Last Update Date | 16/08/2013 |