Healthcare Provider Details

I. General information

NPI: 1780985606
Provider Name (Legal Business Name): LOURDES M AVILES-RIOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2010
Last Update Date: 05/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 YORK STREET YALE-NEW HAVEN HOSPITAL
NEW HAVEN CT
06510
US

IV. Provider business mailing address

33 CEDAR STREET, 420 LSOG YALE UNIVERSITY SCHOOL OF MEDICINE PEDIATRIC DEPARTMENT
NEW HAVEN CT
06420-8064
US

V. Phone/Fax

Practice location:
  • Phone: 787-756-4020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number12,705-I
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number20818
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: