Healthcare Provider Details

I. General information

NPI: 1144140187
Provider Name (Legal Business Name): ALAN JOSE AVILES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 CALLE DR BASORA N
MAYAGUEZ PR
00680-4833
US

IV. Provider business mailing address

VILLA LUISA CALLE TURQUESA 106
CABO ROJO PR
00623
US

V. Phone/Fax

Practice location:
  • Phone: 787-834-0101
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number17709-I
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: