Provider Demographics
NPI:1205039104
Name:ANTRON AVILA, CRISTOBAL (MD)
Entity Type:Individual
Prefix:DR
First Name:CRISTOBAL
Middle Name:
Last Name:ANTRON AVILA
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:PMB 108 PO. BOX 70005
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-0005
Mailing Address - Country:US
Mailing Address - Phone:787-887-1819
Mailing Address - Fax:787-888-0202
Practice Address - Street 1:URB. BRISAS DEL MAR
Practice Address - Street 2:EDIFICIO SONNY CITY CALLE 2-J-6
Practice Address - City:LUQUILLO
Practice Address - State:PR
Practice Address - Zip Code:00738-0005
Practice Address - Country:US
Practice Address - Phone:939-640-6095
Practice Address - Fax:787-888-0202
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10988208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice