1356486054 NPI number — MRS. GENOVEVA MARIA AVALOS-MIRELES MSW LCSW

Table of content: MRS. GENOVEVA MARIA AVALOS-MIRELES MSW LCSW (NPI 1356486054)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356486054 NPI number — MRS. GENOVEVA MARIA AVALOS-MIRELES MSW LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AVALOS-MIRELES
Provider First Name:
GENOVEVA
Provider Middle Name:
MARIA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356486054
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2045
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRING VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91979-2045
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-818-6533
Provider Business Mailing Address Fax Number:
187-782-5946

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9628 CAMPO RD
Provider Second Line Business Practice Location Address:
SUITE T
Provider Business Practice Location Address City Name:
SPRING VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91977-1245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-818-6533
Provider Business Practice Location Address Fax Number:
187-782-5946
Provider Enumeration Date:
02/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  LCSW 21116 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com