Individual
DIANA AVALOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
500 ALLERTON ST, REDWOOD CITY, CA 94063-1519
(650) 599-9955
Mailing address
PO BOX 10501, SAN JOSE, CA 95157-1501
(714) 717-2963
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
324500000X
Substance Abuse Rehabilitation Facility
RI-A1004152144
CA
Other
Enumeration date
07/11/2011
Last updated
01/25/2018
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