Provider Demographics
NPI:1144835000
Name:AVILA, CESAR ANTONIO (PA)
Entity type:Individual
Prefix:
First Name:CESAR
Middle Name:ANTONIO
Last Name:AVILA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 79459
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-9459
Mailing Address - Country:US
Mailing Address - Phone:787-918-6212
Mailing Address - Fax:
Practice Address - Street 1:1400 AVE MAGDALENA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-2158
Practice Address - Country:US
Practice Address - Phone:787-397-4633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0033363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical