Provider Demographics
NPI:1992781983
Name:PAVIA, ANTONIO M (MD)
Entity type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:M
Last Name:PAVIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ANTONIO
Other - Middle Name:M
Other - Last Name:PAVIA-CABANILLAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:431 AVE PONCE DE LEON
Mailing Address - Street 2:NATIONAL PLAZA, SUITE 328
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-3418
Mailing Address - Country:US
Mailing Address - Phone:787-281-3838
Mailing Address - Fax:787-281-0124
Practice Address - Street 1:431 AVE PONCE DE LEON
Practice Address - Street 2:NATIONAL PLAZA, SUITE 328
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-3418
Practice Address - Country:US
Practice Address - Phone:787-281-3838
Practice Address - Fax:787-281-0124
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8235208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D32336Medicare UPIN