Provider Demographics
NPI:1275396905
Name:FELICIANO AVILES, CAMILA CRISTAL (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAMILA
Middle Name:CRISTAL
Last Name:FELICIANO AVILES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 2 BOX 7895
Mailing Address - Street 2:
Mailing Address - City:HORMIGUEROS
Mailing Address - State:PR
Mailing Address - Zip Code:00660-9723
Mailing Address - Country:US
Mailing Address - Phone:939-284-0888
Mailing Address - Fax:
Practice Address - Street 1:AVENIDA UNIVERSIDAD INTERAMERICANA SUITE 202
Practice Address - Street 2:
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-0068
Practice Address - Country:US
Practice Address - Phone:787-901-8088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR007347103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist