Provider Demographics
NPI:1477607810
Name:AVILES-GARCIA, AMARILIS (MD)
Entity Type:Individual
Prefix:
First Name:AMARILIS
Middle Name:
Last Name:AVILES-GARCIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 SOUTHPARK BLVD
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5134
Mailing Address - Country:US
Mailing Address - Phone:904-829-0814
Mailing Address - Fax:904-824-1165
Practice Address - Street 1:1955 US 1 S STE 200
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5786
Practice Address - Country:US
Practice Address - Phone:904-494-2841
Practice Address - Fax:904-829-6174
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15189207R00000X
FLME102471207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine