Individual
ANTHONY AVALOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
555 TECHNOLOGY CT STE 105, RIVERSIDE, CA 92507-2155
(951) 285-2650
Mailing address
4545 MEREDITH ST, RIVERSIDE, CA 92505-1536
(951) 415-3263
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
01/29/2020
Last updated
03/20/2020
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