Healthcare Provider Details

I. General information

NPI: 1255531992
Provider Name (Legal Business Name): FERNANDO JOSE AVILES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: FERNANDO JOSE AVILES-CEVASCO MD

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 08/14/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 E REDD RD BLDG B
EL PASO TX
79912-7275
US

IV. Provider business mailing address

1387 GEORGE DIETER DR STE 106-D
EL PASO TX
79936-7410
US

V. Phone/Fax

Practice location:
  • Phone: 915-581-0712
  • Fax: 915-533-8680
Mailing address:
  • Phone: 915-581-0712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License NumberN7210
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberN7210
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberN7210
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: