Individual
NOEMI AVILA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11980 MOUNT VERNON AVE, GRAND TERRACE, CA 92313-5172
(909) 864-1097
(951) 225-6879
Mailing address
11980 MOUNT VERNON AVE, GRAND TERRACE, CA 92313-5172
(909) 864-1097
(951) 225-6879
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
95022305
CA
Other
Enumeration date
04/30/2021
Last updated
11/15/2022
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