Provider Demographics
NPI:1245783034
Name:AVILES BURGOS MEDICAL GROUP & HOSPITALIST SERVICES
Entity Type:Organization
Organization Name:AVILES BURGOS MEDICAL GROUP & HOSPITALIST SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YANIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:AVILES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-721-3444
Mailing Address - Street 1:PO BOX 19325
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-1325
Mailing Address - Country:US
Mailing Address - Phone:787-721-3444
Mailing Address - Fax:787-721-3458
Practice Address - Street 1:1399 CALLE FERIA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2519
Practice Address - Country:US
Practice Address - Phone:787-518-5304
Practice Address - Fax:787-721-3458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR311203OtherREGISTRO