Healthcare Provider Details

I. General information

NPI: 1871403659
Provider Name (Legal Business Name): GABRIEL JESUS AVILES MATIAS RPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 CALLE CUEVAS BUSTAMANTE APT 1010
SAN JUAN PR
00918-3833
US

IV. Provider business mailing address

650 CALLE CUEVAS BUSTAMANTE APT 1010
SAN JUAN PR
00918-3833
US

V. Phone/Fax

Practice location:
  • Phone: 787-787-8669
  • Fax: 787-786-7865
Mailing address:
  • Phone: 787-787-8669
  • Fax: 787-786-7865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4711
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: