Provider Demographics
NPI:1790014678
Name:AVILES OLIVER, ALEX O
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:O
Last Name:AVILES OLIVER
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:B8 CALLE MILAGROS CABEZAS
Mailing Address - Street 2:CAROLINA ALTA
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-7108
Mailing Address - Country:US
Mailing Address - Phone:787-768-1835
Mailing Address - Fax:787-257-4034
Practice Address - Street 1:B-8 MILAGROS CABEZAS ST.
Practice Address - Street 2:CAROLINA ALTA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987
Practice Address - Country:US
Practice Address - Phone:787-768-1835
Practice Address - Fax:787-257-4034
Is Sole Proprietor?:No
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7010183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7010OtherSTATE LICENSE