Healthcare Provider Details

I. General information

NPI: 1659310167
Provider Name (Legal Business Name): VICTOR ANIBAL AVILES PSYD.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 CALLE SANTA CRUZ
BAYAMON PR
00961-6953
US

IV. Provider business mailing address

59 CALLE SANTA CRUZ
BAYAMON PR
00961-6953
US

V. Phone/Fax

Practice location:
  • Phone: 787-523-4315
  • Fax:
Mailing address:
  • Phone: 787-523-4315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5340
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2721
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: