1487016390 NPI number — DR. MAURICIO JOSE AVILA GUERRA M.D.

Table of content: DR. MAURICIO JOSE AVILA GUERRA M.D. (NPI 1487016390)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487016390 NPI number — DR. MAURICIO JOSE AVILA GUERRA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AVILA GUERRA
Provider First Name:
MAURICIO
Provider Middle Name:
JOSE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AVILA
Provider Other First Name:
MAURICIO
Provider Other Middle Name:
J.
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1487016390
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1008 S SPRING AVE RM 3100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63110-2520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
146-173-5463
Provider Business Mailing Address Fax Number:
314-617-3430

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 S GRAND BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63104-1016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-617-3420
Provider Business Practice Location Address Fax Number:
314-617-3430
Provider Enumeration Date:
03/22/2016

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: 207T00000X , with the licence number:  2023009168 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com