Provider Demographics
NPI:1730424284
Name:AVILA, CECILIA ELIZABETH (PA-C)
Entity type:Individual
Prefix:MRS
First Name:CECILIA
Middle Name:ELIZABETH
Last Name:AVILA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:CECILIA
Other - Middle Name:ELIZABETH
Other - Last Name:AREVALO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2446 79TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11370-1565
Mailing Address - Country:US
Mailing Address - Phone:718-316-2018
Mailing Address - Fax:718-446-5939
Practice Address - Street 1:2133 31ST ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-2601
Practice Address - Country:US
Practice Address - Phone:929-457-7650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-10
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016298363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04353559Medicaid
NY560073976OtherSTATE ID
NYG400339473OtherPECOS