Provider Demographics
NPI:1386767556
Name:AVISANT GRUPO MEDICO, CSP
Entity type:Organization
Organization Name:AVISANT GRUPO MEDICO, CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:AVILES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-868-9999
Mailing Address - Street 1:PO BOX 2069
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-2069
Mailing Address - Country:US
Mailing Address - Phone:787-868-9999
Mailing Address - Fax:787-868-9999
Practice Address - Street 1:CARR 115 KM 0.1 AVE. ROTARIO
Practice Address - Street 2:EDIFICIO ROSA SUITE # 201
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602
Practice Address - Country:US
Practice Address - Phone:787-868-9999
Practice Address - Fax:787-868-9999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12624208000000X
PR14910208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR167151Medicare ID - Type UnspecifiedDR. M. SANTIAGO MEDICARE
PR167146Medicare ID - Type UnspecifiedDR. H AVILES MEDICARE NUM