Provider Demographics
NPI:1558052316
Name:ORTIZ AVILES, ABIMAEL
Entity Type:Individual
Prefix:
First Name:ABIMAEL
Middle Name:
Last Name:ORTIZ AVILES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 44808
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-6228
Mailing Address - Country:US
Mailing Address - Phone:939-264-4522
Mailing Address - Fax:
Practice Address - Street 1:CARR. 125 KM 18.3
Practice Address - Street 2:BO. GUATEMALA
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-0001
Practice Address - Country:US
Practice Address - Phone:939-264-4522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty