Provider Demographics
NPI:1710546585
Name:AVINA, ANDREA PEREZ (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:PEREZ
Last Name:AVINA
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 GARRY CT
Mailing Address - Street 2:
Mailing Address - City:ARBUCKLE
Mailing Address - State:CA
Mailing Address - Zip Code:95912-9569
Mailing Address - Country:US
Mailing Address - Phone:530-723-3972
Mailing Address - Fax:
Practice Address - Street 1:501 JESSIE AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95838-2608
Practice Address - Country:US
Practice Address - Phone:916-922-8855
Practice Address - Fax:916-922-6208
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
CA30083235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist