Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 18526 | CA |
NPI | 1003067950 |
---|---|
Provider Name | Mrs. Pamela Lynn Avila |
First Address | Porterville, CA 93257-3260 |
Second Address | Porterville, CA 93257-3260 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2008 |
Last Update Date | 08/10/2008 |