Healthcare Provider Details

I. General information

NPI: 1053751099
Provider Name (Legal Business Name): ANA SILVIA DEL SOCORRO HERNANDEZ AVILES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2013
Last Update Date: 07/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 N MAIN ST LACONIA CLINIC
LACONIA NH
03246-2742
US

IV. Provider business mailing address

PO BOX 1327
LACONIA NH
03247-1327
US

V. Phone/Fax

Practice location:
  • Phone: 603-527-2711
  • Fax: 603-528-1085
Mailing address:
  • Phone: 603-524-3211
  • Fax: 603-527-7038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number17338
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: