Healthcare Provider Details

I. General information

NPI: 1053313353
Provider Name (Legal Business Name): OSVALDO AVILES VAZQUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 03/03/2020
Certification Date: 03/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 LUIS MUNOZ RIVERA
CABO ROJO PR
00623
US

IV. Provider business mailing address

EXTENSION MONTESOL 3004 CALLE YAUREL
CABO ROJO PR
00623
US

V. Phone/Fax

Practice location:
  • Phone: 787-851-2555
  • Fax: 787-851-1133
Mailing address:
  • Phone: 787-851-2555
  • Fax: 787-851-1133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number10059
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: