Mary Jane Laceda Avila, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

1176807 Issued in TX

Practice address

622 Isom Rd Ste 101
San Antonio, TX 78216-4457

Phone

(210) 622-8000

NPI assigned

Oct 8, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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

• Medical Vein Clinic

  • Diagnostic Radiology Physician
  • San Antonio, TX
  • NPI 1538696471
  Medicare reassignment NPD

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

{
    "created_epoch": "1728345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728345600000",
    "number": "1396564209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9554 WITTEN DR",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782542179",
            "telephone_number": "210-232-3794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "622 ISOM RD STE 101",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782164457",
            "telephone_number": "210-622-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AVILA",
        "first_name": "MARY JANE",
        "middle_name": "LACEDA",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-08",
        "last_updated": "2024-10-08",
        "certification_date": "2024-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1176807",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Evangelina L Avila
• Gerardo Avila, DPT
• Jeanette Avila, RN, BSN
• Laura Leal Avila, PHD
• Maricela Avila
• Shelly Avila
• Amy Aviles
• Erick Aviles
• Jaime Aviles
• Natalia Aviles

• Family Nurse Practitioner in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.