Healthcare Provider Details

I. General information

NPI: 1144345315
Provider Name (Legal Business Name): TERESITA A. AVILES - RODRIGUEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 06/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CIRUGIA PEDIATRICA SEGUNDO PISO HOSPITAL PEDIATRICO UNIVERSITARIO, CENTRO MEDICO DE PR
SAN JUAN PR
00935-0001
US

IV. Provider business mailing address

PO BOX 362875
SAN JUAN PR
00936-2875
US

V. Phone/Fax

Practice location:
  • Phone: 787-777-3535
  • Fax: 787-773-0832
Mailing address:
  • Phone: 787-777-3535
  • Fax: 787-773-0832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number4501
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: