Healthcare Provider Details

I. General information

NPI: 1346825536
Provider Name (Legal Business Name): MARIA LEONOR AVILES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2021
Last Update Date: 03/10/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CALLE MANUEL F PAVIA ESQ AVE FERNANDEZ JUNCOS SUITE 301
SAN JUAN PR
00909
US

IV. Provider business mailing address

700 CALLE MANUEL F PAVIA ESQ AVE FERNANDEZ JUNCOS SUITE 301
SAN JUAN PR
00909
US

V. Phone/Fax

Practice location:
  • Phone: 787-496-0818
  • Fax: 787-982-6464
Mailing address:
  • Phone: 787-496-0818
  • Fax: 787-982-6464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: