Individual
MAYRA TERESA AVILA LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1401 L ST, BAKERSFIELD, CA 93301-4522
(661) 868-6100
Mailing address
5284 ADOLFO RD STE 100, CAMARILLO, CA 93012-6790
(805) 289-0120
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
13861
CA
Other
Enumeration date
12/09/2022
Last updated
09/06/2023
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