Active NPI
Christal Avila
- Clinical Social Worker
- San Bernardino, CA
National Provider Identifier
1912308149
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 88330
- Practice address
- 202 E Airport Dr Ste 138
San Bernardino, CA 92408-3428 - Phone
- (562) 536-7584
- Fax
- (562) 216-2337
- NPI assigned
- Sep 8, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Clinical Social Worker | 1041C0700X | 88330 | CA | Primary |
Addresses
Primary practice location
202 E Airport Dr Ste 138
San Bernardino, CA 92408-3428
Mailing address
11996 Spartan LN
Fontana, CA 92337-9070
Phone (562) 536-7584
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: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210930003156 | CA | Practitioner - Clinical Social Worker | 4981001161 | Practice locations: San Bernardino, CA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 88330 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1410134400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695686400000",
"number": "1912308149",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11996 SPARTAN LN",
"city": "FONTANA",
"state": "CA",
"postal_code": "923379070",
"telephone_number": "562-536-7584"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "202 E AIRPORT DR STE 138",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924083428",
"telephone_number": "562-536-7584",
"fax_number": "562-216-2337"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AVILA",
"first_name": "CHRISTAL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-09-08",
"last_updated": "2023-09-26",
"certification_date": "2023-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "88330",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Bernardino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2023; 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.