Provider Demographics
NPI:1164460739
Name:TALAVERA-AVILES, IDALIA (MD)
Entity Type:Individual
Prefix:DR
First Name:IDALIA
Middle Name:
Last Name:TALAVERA-AVILES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:IDALIA
Other - Middle Name:
Other - Last Name:TALAVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1200 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-4724
Mailing Address - Country:US
Mailing Address - Phone:954-791-3090
Mailing Address - Fax:954-791-3166
Practice Address - Street 1:1200 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-4724
Practice Address - Country:US
Practice Address - Phone:954-791-3090
Practice Address - Fax:954-791-3166
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85186207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266388100Medicaid
FL29049ZOtherGROUP MEDICARE PIN
FL7953427OtherAETNA PROVIDER NUMBER
FL542129332OtherTAX ID
FL29049OtherBCBS PROVIDER NUMBER
FL29049OtherBCBS PROVIDER NUMBER
FL542129332OtherTAX ID