Individual
ANTHONY VIDAURRI AVITABILE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
13223 BLACK MOUNTAIN RD # 1358, SAN DIEGO, CA 92129-2698
(858) 753-5082
Mailing address
13223 BLACK MOUNTAIN RD # 1358, SAN DIEGO, CA 92129-2698
(858) 753-5082
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
28983
CA
Other
Enumeration date
11/11/2019
Last updated
11/11/2019
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