Provider Demographics
NPI:1063612315
Name:AVILES, ADOLFO
Entity type:Individual
Prefix:MR
First Name:ADOLFO
Middle Name:
Last Name:AVILES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 758
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678
Mailing Address - Country:US
Mailing Address - Phone:787-895-8917
Mailing Address - Fax:787-826-3600
Practice Address - Street 1:67 CALLE 65 INFANTERIA
Practice Address - Street 2:SUITE B 208
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610-1670
Practice Address - Country:US
Practice Address - Phone:787-826-0770
Practice Address - Fax:787-826-3600
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTC-AMB-2013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR59382Medicare PIN