Provider Demographics
NPI:1285611780
Name:AVILES, WILFREDO JOSE (MD)
Entity type:Individual
Prefix:DR
First Name:WILFREDO
Middle Name:JOSE
Last Name: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:URB. MONTE BELLO
Mailing Address - Street 2:#775 ST. PETIRROJO
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-9473
Mailing Address - Country:US
Mailing Address - Phone:787-242-4336
Mailing Address - Fax:
Practice Address - Street 1:PUERTA DEL SOL BUSINESS CENTER
Practice Address - Street 2:CARR. #2 SEGUNDO PISO OFICINA #1
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-884-2365
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15483207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine