Provider Demographics
NPI:1215273636
Name:CLINICA PODIATRICA AVILES, CSP
Entity type:Organization
Organization Name:CLINICA PODIATRICA AVILES, CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HILDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:AVILES-VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:939-292-4627
Mailing Address - Street 1:PO BOX 986
Mailing Address - Street 2:
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667-0986
Mailing Address - Country:US
Mailing Address - Phone:939-292-4627
Mailing Address - Fax:
Practice Address - Street 1:2431 AVE LAS AMERICAS EDIFICIO PORRATA PILA
Practice Address - Street 2:SUITE 208
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717
Practice Address - Country:US
Practice Address - Phone:939-292-4627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR109213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty