Provider Demographics
NPI:1407423494
Name:REXACH AVILES, JUAN EDUARDO (MD MLS (ASCP)CM)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:EDUARDO
Last Name:REXACH AVILES
Suffix:
Gender:M
Credentials:MD MLS (ASCP)CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE B C22
Mailing Address - Street 2:URB. MELENDEZ
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738
Mailing Address - Country:US
Mailing Address - Phone:787-556-8781
Mailing Address - Fax:
Practice Address - Street 1:CARR 188 # INT187
Practice Address - Street 2:
Practice Address - City:LOIZA
Practice Address - State:PR
Practice Address - Zip Code:00772-1850
Practice Address - Country:US
Practice Address - Phone:787-876-2042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-08
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23228208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice