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General NPI Number Information
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NPI Number | 1376157933
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Entity Type | Individual
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Provider Name | JESUS E AVILES ATC
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Gender | Male
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Dates
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Enumeration Date | 09/01/2020
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Last Update Date | 09/01/2020
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Provider Practice Location Address
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Address Line | 755 BATTERY AVE SE
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City | ATLANTA
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State | GA
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Zip | 30339-3017
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Country | US
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Telephone | 404-577-9100
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Fax |
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Provider Business Mailing Address
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Address Line | HC 5 BOX 7281
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City | YAUCO
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State | PR
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Zip | 00698-9721
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Country | US
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Telephone | 787-207-7302
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Fax |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0001904
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License Number State | CO
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