Provider Demographics
NPI:1154594810
Name:AVILES MELENDEZ, BENJAMIN
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:AVILES MELENDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:B A MEDICAL
Other - Middle Name:
Other - Last Name:TRANSPORT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:HC 2 BOX 6532
Mailing Address - Street 2:
Mailing Address - City:MOROVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00687-9736
Mailing Address - Country:US
Mailing Address - Phone:787-369-5572
Mailing Address - Fax:
Practice Address - Street 1:CARR 6622 KM .7
Practice Address - Street 2:SECTOR LA LINEA
Practice Address - City:MOROVIS
Practice Address - State:PR
Practice Address - Zip Code:00687
Practice Address - Country:US
Practice Address - Phone:787-369-5572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTC-AMB 5123416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport