Provider Demographics
NPI:1053313353
Name:AVILES VAZQUEZ, OSVALDO (MD)
Entity Type:Individual
Prefix:DR
First Name:OSVALDO
Middle Name:
Last Name:AVILES VAZQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EXTENSION MONTESOL 3004
Mailing Address - Street 2:CALLE YAUREL
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623
Mailing Address - Country:US
Mailing Address - Phone:787-851-2555
Mailing Address - Fax:787-851-1133
Practice Address - Street 1:35 LUIS MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623
Practice Address - Country:US
Practice Address - Phone:787-851-2555
Practice Address - Fax:787-851-1133
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10059207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR81824Medicare ID - Type Unspecified
PRF47576Medicare UPIN