Healthcare Provider Details

I. General information

NPI: 1639225345
Provider Name (Legal Business Name): WILFREDO AVILES, MD P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 E 6TH ST
WESLACO TX
78596-6601
US

IV. Provider business mailing address

1313 E 6TH ST
WESLACO TX
78596-6601
US

V. Phone/Fax

Practice location:
  • Phone: 956-968-3111
  • Fax: 956-968-1113
Mailing address:
  • Phone: 956-968-3111
  • Fax: 956-968-1113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. WILFREDO A AVILES
Title or Position: MEDICAL SUPERVISOR
Credential: M.D.
Phone: 956-968-3111