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: 05/26/2026
Certification Date: 05/26/2026
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

201 E SAMPLE RD
DEERFIELD BEACH FL
33064-3502
US

V. Phone/Fax

Practice location:
  • Phone: 954-463-0112
  • Fax:
Mailing address:
  • Phone: 954-941-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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: