Provider Demographics
NPI:1962860429
Name:GONZALEZ AVILES, SACHA CRISTIN MARRIE (MD)
Entity Type:Individual
Prefix:
First Name:SACHA
Middle Name:CRISTIN MARRIE
Last Name:GONZALEZ 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 1:1040 CALLE B
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682-7634
Mailing Address - Country:US
Mailing Address - Phone:787-455-0321
Mailing Address - Fax:
Practice Address - Street 1:1040 CALLE B
Practice Address - Street 2:PARCELAS SOLEDAD
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-7634
Practice Address - Country:US
Practice Address - Phone:787-455-0321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-29
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19209208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice