Healthcare Provider Details

I. General information

NPI: 1982917969
Provider Name (Legal Business Name): RICHARD ANTHONY AVILES MICHEL PH.D, ABPDN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2010
Last Update Date: 06/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 AVE. PONCE DE LEON SUITE 111
SAN JUAN PR
00909
US

IV. Provider business mailing address

264 HOWARD STREET UNIVERSITY GARDENS
SAN JUAN PR
00927
US

V. Phone/Fax

Practice location:
  • Phone: 787-725-0985
  • Fax:
Mailing address:
  • Phone: 787-226-4992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0031
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: