Provider Demographics
NPI:1861274763
Name:AVILA, LINDA M (FNP-C, FNP-BC)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:AVILA
Suffix:
Gender:F
Credentials:FNP-C, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6816 PACIFIC BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-4654
Mailing Address - Country:US
Mailing Address - Phone:818-754-7986
Mailing Address - Fax:888-674-0501
Practice Address - Street 1:6816 PACIFIC BLVD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-4348
Practice Address - Country:US
Practice Address - Phone:818-754-7986
Practice Address - Fax:888-674-0501
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95025412363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty