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General NPI Number Information
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NPI Number | 1780985606
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Entity Type | Individual
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Provider Name | LOURDES M AVILES-RIOS MD
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Gender | Female
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Dates
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Enumeration Date | 11/09/2010
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Last Update Date | 05/29/2014
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Provider Practice Location Address
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Address Line | 20 YORK STREET YALE-NEW HAVEN HOSPITAL
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City | NEW HAVEN
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State | CT
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Zip | 06510
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Country | US
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Telephone | 787-756-4020
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Fax |
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Provider Business Mailing Address
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Address Line | 33 CEDAR STREET, 420 LSOG YALE UNIVERSITY SCHOOL OF MEDICINE PEDIATRIC DEPARTMENT
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City | NEW HAVEN
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State | CT
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Zip | 06420-8064
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Country | US
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Telephone |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 12,705-I
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 20818
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License Number State | PR
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