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1134777972
MARIO ALBERTO AVALOS REBOLLAR
SANTA ANA, CA
NPI
1134777972
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
390200000X Student in an Organized Health Care Education/Training Program
(Licence: CA INT44618)
Enumeration Date
2019-08-26
Last Update Date
2019-08-26
Business Address
MARIO ALBERTO AVALOS REBOLLAR
2718 W ANAHURST PL
SANTA ANA, CA 92704-4506
Phone number: 714-264-2974
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Mailing Address
MARIO ALBERTO AVALOS REBOLLAR
2718 W ANAHURST PL
SANTA ANA, CA 92704-4506
Phone number: 714-264-2974
Copy
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