| NPI | 1760832117 |
|---|---|
| Former Name | LACEY AVILA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0127X Surgery Trauma Surgery (Licence: FL ME148659) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL TRN 23830) |
| 2086S0102X Surgery Surgical Critical Care (Licence: MA 1017531) | |
| 2086S0127X Surgery Trauma Surgery (Licence: MA 1017531) | |
| Enumeration Date | 2016-06-16 |
| Last Update Date | 2025-08-02 |