Individual
FANNY RAQUEL AVILES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1904 RICHLAND AVE # D, CERES, CA 95307-4562
(209) 552-9878
Mailing address
1904 RICHLAND AVE # D, CERES, CA 95307-4562
(209) 552-9878
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
04/30/2019
Last updated
04/30/2019
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