Provider Demographics
NPI:1588723191
Name:AYMAT AVILA, JOSE R (MT)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:R
Last Name:AYMAT AVILA
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1119
Mailing Address - Street 2:
Mailing Address - City:CATANO
Mailing Address - State:PR
Mailing Address - Zip Code:00963
Mailing Address - Country:US
Mailing Address - Phone:787-788-2051
Mailing Address - Fax:787-788-6150
Practice Address - Street 1:52 TREN
Practice Address - Street 2:
Practice Address - City:CATANO
Practice Address - State:PR
Practice Address - Zip Code:00962
Practice Address - Country:US
Practice Address - Phone:787-788-2051
Practice Address - Fax:787-788-6150
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2522246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
30444Medicare ID - Type Unspecified