Provider Demographics
NPI:1689756330
Name:AVILA, ARTURO R (PA-C)
Entity type:Individual
Prefix:
First Name:ARTURO
Middle Name:R
Last Name:AVILA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39300 CIVIC CENTER DR STE 370
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2397
Mailing Address - Country:US
Mailing Address - Phone:510-248-1000
Mailing Address - Fax:
Practice Address - Street 1:38690 STIVERS ST STE A
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-5276
Practice Address - Country:US
Practice Address - Phone:510-248-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA12108363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA12108Medicaid
CAAZ577ZOtherPTAN
S30713Medicare UPIN