Provider Demographics
NPI:1235224585
Name:ADOLFO AVILES
Entity Type:Organization
Organization Name:ADOLFO AVILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADOLFO
Authorized Official - Middle Name:
Authorized Official - Last Name:AVILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-826-0770
Mailing Address - Street 1:65 CALLE 65 INFANTERIA
Mailing Address - Street 2:SUITE 208
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610-2909
Mailing Address - Country:US
Mailing Address - Phone:787-826-0770
Mailing Address - Fax:787-895-4630
Practice Address - Street 1:65 CALLE 65 INFANTERIA
Practice Address - Street 2:SUITE 208
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610-2909
Practice Address - Country:US
Practice Address - Phone:787-826-0770
Practice Address - Fax:787-895-4630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTC-AMB-2013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR59382Medicare PIN