Provider Demographics
NPI:1205933629
Name:RICHARD A. AVILES MICHEL
Entity type:Organization
Organization Name:RICHARD A. AVILES MICHEL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC NEUROPSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:AVILES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, ABPDN
Authorized Official - Phone:787-725-0985
Mailing Address - Street 1:264 HOWARD STREET
Mailing Address - Street 2:UNIVERSITY GARDENS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927
Mailing Address - Country:US
Mailing Address - Phone:787-226-4992
Mailing Address - Fax:
Practice Address - Street 1:1605 AVE PONCE DE LEON STE 111
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-1811
Practice Address - Country:US
Practice Address - Phone:787-725-0985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0031261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)