Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | A171106 | CA |
N | 208D00000X | General Practice Physician | MD-19508 | HI |
NPI | 1013366889 |
---|---|
Provider Name | Dr. Michael Patrick Avillion |
First Address | Los Angeles, CA 90057-1999 |
Second Address | Los Angeles, CA 90057-1999 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2016 |
Last Update Date | 04/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
VAD000 | (02) |