Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1013460427 |
---|---|
Provider Name | Lizbeth Avila |
First Address | Van Nuys, CA 91402 |
Second Address | Van Nuys, CA 91402-4345 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2016 |
Last Update Date | 02/08/2016 |