Provider Demographics
NPI:1205837010
Name:AVILES, RICARDO A (MD)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:A
Last Name:AVILES
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 1:2445 E WILCOX DR
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2842
Mailing Address - Country:US
Mailing Address - Phone:520-458-8131
Mailing Address - Fax:520-458-0422
Practice Address - Street 1:2445 E WILCOX DR
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2842
Practice Address - Country:US
Practice Address - Phone:520-458-8131
Practice Address - Fax:520-458-0422
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32367207W00000X
WY7754A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1205837010Medicaid
AZ874158Medicaid
AZ874158Medicaid
WY1205837010Medicaid
WY21543Medicare PIN