Healthcare Provider Details

I. General information

NPI: 1386767556
Provider Name (Legal Business Name): AVISANT GRUPO MEDICO, CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 115 KM 0.1 AVE. ROTARIO EDIFICIO ROSA SUITE # 201
AGUADA PR
00602
US

IV. Provider business mailing address

PO BOX 2069
AGUADA PR
00602-2069
US

V. Phone/Fax

Practice location:
  • Phone: 787-868-9999
  • Fax: 787-868-9999
Mailing address:
  • Phone: 787-868-9999
  • Fax: 787-868-9999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number12624
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number14910
License Number StatePR

VIII. Authorized Official

Name: DR. HECTOR MANUEL AVILES
Title or Position: PRESIDENT
Credential: MD
Phone: 787-868-9999