Provider Demographics
NPI:1093888554
Name:AVILES, MARIBEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIBEL
Middle Name:
Last Name:AVILES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 S SEMORAN BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-1458
Mailing Address - Country:US
Mailing Address - Phone:407-282-4142
Mailing Address - Fax:407-282-7475
Practice Address - Street 1:1170 S SEMORAN BLVD STE D
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-1458
Practice Address - Country:US
Practice Address - Phone:407-282-4142
Practice Address - Fax:407-282-7475
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66465207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF40961Medicare UPIN