Provider Demographics
NPI:1790701597
Name:AVILES, XAVIER ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:XAVIER
Middle Name:ANTONIO
Last Name:AVILES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:XAVIER
Other - Middle Name:A
Other - Last Name:AVILES GUZMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2525 SW 75TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-2800
Mailing Address - Country:US
Mailing Address - Phone:305-260-1852
Mailing Address - Fax:305-265-4824
Practice Address - Street 1:2525 SW 75TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-2800
Practice Address - Country:US
Practice Address - Phone:305-260-1852
Practice Address - Fax:305-265-4824
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME115863208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02020515Medicaid
NYH05211Medicare UPIN
NY02020515Medicaid