Provider Demographics
NPI:1124174214
Name:MEDINA AVILES, LUIS ALBERTO (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ALBERTO
Last Name:MEDINA AVILES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 2 BOX 6870
Mailing Address - Street 2:
Mailing Address - City:BAJADERO
Mailing Address - State:PR
Mailing Address - Zip Code:00616-9771
Mailing Address - Country:US
Mailing Address - Phone:787-815-3239
Mailing Address - Fax:787-650-9884
Practice Address - Street 1:CARR. 638 KM 0.1
Practice Address - Street 2:DOMINGO RUIZ
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00616
Practice Address - Country:US
Practice Address - Phone:787-815-3239
Practice Address - Fax:787-650-9884
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12097207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine