Provider Demographics
NPI:1427049170
Name:AVILES-SANTA, MAINES LARISSA (MD)
Entity type:Individual
Prefix:
First Name:MAINES
Middle Name:LARISSA
Last Name:AVILES-SANTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 ROCKLEDGE DRIVE, ROOM 8157
Mailing Address - Street 2:TWO ROCKLEDGE CTR
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20892-0001
Mailing Address - Country:US
Mailing Address - Phone:301-435-1284
Mailing Address - Fax:301-480-1667
Practice Address - Street 1:2 ROCKLEDGE CTR
Practice Address - Street 2:6701 ROCKLEDGE DRIVE, ROOM 8157
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-0001
Practice Address - Country:US
Practice Address - Phone:301-435-1284
Practice Address - Fax:301-480-1667
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9615207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG45017Medicare UPIN