Provider Demographics
NPI:1639225345
Name:WILFREDO AVILES, MD P.A.
Entity Type:Organization
Organization Name:WILFREDO AVILES, MD P.A.
Other - Org Name:MID VALLEY PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL SUPERVISOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILFREDO
Authorized Official - Middle Name:A
Authorized Official - Last Name:AVILES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-968-3111
Mailing Address - Street 1:1313 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-6601
Mailing Address - Country:US
Mailing Address - Phone:956-968-3111
Mailing Address - Fax:956-968-1113
Practice Address - Street 1:1313 E 6TH ST
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6601
Practice Address - Country:US
Practice Address - Phone:956-968-3111
Practice Address - Fax:956-968-1113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127150406Medicaid
TX127150402Medicaid