Healthcare Provider Details

I. General information

NPI: 1114595014
Provider Name (Legal Business Name): CINTHYA CAROLINA AVILES RIASCOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date: 04/06/2023
Reactivation Date: 07/15/2024

III. Provider practice location address

16501 NW 2ND AVE
MIAMI FL
33169-6005
US

IV. Provider business mailing address

850 W RIO SALADO PKWY STE 201
TEMPE AZ
85281-3812
US

V. Phone/Fax

Practice location:
  • Phone: 305-354-4558
  • Fax:
Mailing address:
  • Phone: 305-354-4558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME169485
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: