Provider Demographics
NPI:1366844391
Name:JOPHRYN-AVILA, PAMELA L
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:L
Last Name:JOPHRYN-AVILA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44554 BENALD ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-3438
Mailing Address - Country:US
Mailing Address - Phone:562-212-6473
Mailing Address - Fax:
Practice Address - Street 1:2260 E PALMDALE BLVD STE J
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-4952
Practice Address - Country:US
Practice Address - Phone:661-575-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-22
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00727993171M00000X
CA8919225400000X
CAASW125474104100000X
CA8219101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)