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General NPI Number Information
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NPI Number | 1124174214
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Entity Type | Individual
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Provider Name | LUIS ALBERTO MEDINA AVILES MD
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Gender | Male
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 11/26/2019
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Provider Practice Location Address
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Address Line | CARR. 638 KM 0.1 DOMINGO RUIZ
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City | ARECIBO
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State | PR
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Zip | 00616
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Country | US
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Telephone | 787-815-3239
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Fax | 787-650-9884
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Provider Business Mailing Address
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Address Line | HC 2 BOX 6870
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City | BAJADERO
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State | PR
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Zip | 00616-9771
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Country | US
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Telephone | 787-815-3239
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Fax | 787-650-9884
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 12097
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License Number State | PR
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