Individual provider Active NPI

Jonathan Tiago Avila, M.D.

  • Pediatric Adolescent Medicine Physician
  • Palo Alto, CA
National Provider Identifier
1063754745
Registry record updated Apr 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
License
A139957 Issued in CA
Practice address
725 Welch Rd
Palo Alto, CA 94304-1601
Phone
(650) 497-8000
NPI assigned
Mar 20, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X A139957 CA
Pediatric Adolescent Medicine Physician 2080A0000X A139957 CA Primary

Addresses

Primary practice location

725 Welch Rd
Palo Alto, CA 94304-1601

Mailing address

725 Welch Rd
Palo Alto, CA 94304-1601
Phone (650) 497-8000

Other practice location 1

770 Welch Rd Ste 100
Palo Alto, CA 94304
Phone (650) 736-9557

Other practice location 2

1195 W Fremont Ave Fl 2
Sunnyvale, CA 94087-3832
Phone (408) 425-5593

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190611001575 CA Practitioner - Pediatric Medicine 5991006611 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A139957CAMDPediatric Adolescent Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Stanford Health Care Pediatrics Current Accepting new patients
Stanford Health Care CurrentSince May 16, 2019 Accepting new patients
Stanford Health Care Pediatrics CurrentSince May 16, 2019 Accepting new patients
LPCH Medical Group Div of Lucile Pediatrics CurrentSince May 16, 2019 Accepting new patients
Stanford Hospital and Clinics Past Accepting new patients
Lucile Salter Packard Children'S Hospital at Stanford Past Accepting new patients

Locations

2495 Hospital Dr
Mountain View, CA 94040
Phone (650) 404-8210

2500 Grant Rd
Mountain View, CA 94040
Phone (650) 903-9500

7999 Gateway Blvd
Ste 200
Newark, CA 94560
Phone (510) 806-2947

770 Welch Rd
Ste 100
Palo Alto, CA 94304
Phone (415) 617-8100

725 Welch Rd
Palo Alto, CA 94304
Phone (650) 497-8979

300 Pasteur Dr
Stanford, CA 94305
Phone (650) 498-5710

1195 W Fremont Ave
Fl 2
Sunnyvale, CA 94087
Phone (408) 425-5593

1195 W Fremont Ave
Sunnyvale, CA 94087
Phone (408) 426-5590

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1363737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712707200000",
    "number": "1063754745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 WELCH RD",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "943041601",
            "telephone_number": "650-497-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 WELCH RD",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "943041601",
            "telephone_number": "650-497-8000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "770 Welch Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Palo Alto",
            "state": "CA",
            "postal_code": "94304",
            "country_code": "US",
            "telephone_number": "650-736-9557",
            "fax_number": "650-736-7706",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1195 W Fremont Ave Fl 2",
            "address_purpose": "LOCATION",
            "city": "Sunnyvale",
            "state": "CA",
            "postal_code": "940873832",
            "country_code": "US",
            "telephone_number": "408-425-5593",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AVILA",
        "first_name": "JONATHAN",
        "middle_name": "TIAGO",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-03-20",
        "last_updated": "2024-04-10",
        "certification_date": "2024-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A139957",
            "primary": false
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "CA",
            "license": "A139957",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palo Alto, CA

Sources for this page

Verify at the official NPI Registry.