Individual
CARLE STEPHANIE AVILA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
17047 E BYGROVE ST, COVINA, CA 91722-1208
(626) 991-0342
Mailing address
17047 E BYGROVE ST, COVINA, CA 91722-1208
(626) 991-0342
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
95027
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
95027
—
CA
Enumeration date
05/25/2021
Last updated
05/25/2021
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