Basic Information
| Provider Information | |||||||||
| NPI: | 1124390794 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AVILA | ||||||||
| FirstName: | MONALISA | ||||||||
| MiddleName: | CHACON | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 748 W ENTERPRISE AVE | ||||||||
| Address2: | |||||||||
| City: | CLOVIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936194839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5593236796 | ||||||||
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| Practice Location | |||||||||
| Address1: | 900 QUEBEC AVE. | ||||||||
| Address2: | |||||||||
| City: | CORCORAN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932127100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5599927100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2012 | ||||||||
| LastUpdateDate: | 01/30/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PSY 23517 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.