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General NPI Number Information
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NPI Number | 1215273636
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Entity Type | Organization
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Legal Business Name | CLINICA PODIATRICA AVILES, CSP
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Dates
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Enumeration Date | 12/13/2012
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Last Update Date | 12/13/2012
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Provider Practice Location Address
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Address Line | 2431 AVE LAS AMERICAS EDIFICIO PORRATA PILA SUITE 208
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City | PONCE
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State | PR
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Zip | 00717
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Country | US
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Telephone | 939-292-4627
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 986
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City | LAJAS
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State | PR
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Zip | 00667-0986
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Country | US
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Telephone | 939-292-4627
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | HILDA J AVILES-VARGAS
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Credential | DPM
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Telephone | 939-292-4627
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 109
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License Number State | PR
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