Provider Demographics
NPI:1790746436
Name:AVILES, ILEANA (MD)
Entity Type:Individual
Prefix:MRS
First Name:ILEANA
Middle Name:
Last Name:AVILES
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 1:1119 CALLE 3
Mailing Address - Street 2:URB VILLA NEVAREZ
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-5132
Mailing Address - Country:US
Mailing Address - Phone:787-756-7109
Mailing Address - Fax:
Practice Address - Street 1:1119 CALLE 3
Practice Address - Street 2:URB VILLA NEVAREZ
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-5132
Practice Address - Country:US
Practice Address - Phone:787-756-7109
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14819207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0023008Medicare ID - Type Unspecified
PRI31054Medicare UPIN