Individual
SOPHIA MADALENA AVILA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1307 FORTINO BLVD STE A, PUEBLO, CO 81008-2377
(719) 582-1010
Mailing address
2840 LANCASTER DR, PUEBLO, CO 81005-3147
(719) 568-2141
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT.0025544
CO
Other
Enumeration date
07/31/2023
Last updated
07/31/2023
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