Healthcare Provider Details

I. General information

NPI: 1003564683
Provider Name (Legal Business Name): YADZIA MARIA AVILES BS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2022
Last Update Date: 03/14/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 411 KM 1.8 INT BO GUAYABO
AGUADA PR
00602-9225
US

IV. Provider business mailing address

HC 60 BOX 29173
AGUADA PR
00602-9225
US

V. Phone/Fax

Practice location:
  • Phone: 787-619-1044
  • Fax:
Mailing address:
  • Phone: 787-619-1044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number00982
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: