Provider Demographics
NPI:1346264207
Name:AVILES MAISONET, JOSE A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:A
Last Name:AVILES MAISONET
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:155 CALLE CARAZO
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00971-7801
Mailing Address - Country:US
Mailing Address - Phone:787-403-8638
Mailing Address - Fax:787-855-2758
Practice Address - Street 1:168 AVE WINSTON CHURCHILL
Practice Address - Street 2:STE 1
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-6013
Practice Address - Country:US
Practice Address - Phone:787-312-0964
Practice Address - Fax:787-756-0964
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2024-05-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR15530208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI25552Medicare UPIN
PR0022948Medicare ID - Type Unspecified