Provider Demographics
NPI:1003564683
Name:AVILES, YADZIA MARIA (BS)
Entity Type:Individual
Prefix:MRS
First Name:YADZIA
Middle Name:MARIA
Last Name:AVILES
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 60 BOX 29173
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-9225
Mailing Address - Country:US
Mailing Address - Phone:787-619-1044
Mailing Address - Fax:
Practice Address - Street 1:CARR 411 KM 1.8 INT BO GUAYABO
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-9225
Practice Address - Country:US
Practice Address - Phone:787-619-1044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR00982225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics