Individual
JOHANNA AVILEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CTRS
Contact information
Practice address
650 E INDIAN SCHOOL RD, PHOENIX, AZ 85012-1839
(602) 448-4505
Mailing address
650 E INDIAN SCHOOL RD, PHOENIX, AZ 85012-1839
(602) 448-4505
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
59164
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
130209
VA
AZ
Enumeration date
02/09/2017
Last updated
02/09/2017
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