Provider Demographics
NPI:1255385977
Name:NAZARIO AVILES, CLARISSA (MD)
Entity type:Individual
Prefix:DR
First Name:CLARISSA
Middle Name:
Last Name:NAZARIO 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:PO BOX 949113
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00694-9113
Mailing Address - Country:US
Mailing Address - Phone:787-391-1294
Mailing Address - Fax:
Practice Address - Street 1:PARCELA 377 SABANA BO, CEIBA
Practice Address - Street 2:PARQUE INDUSTRIAL DCH KILOMETRO 48.6 MANTI
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00694
Practice Address - Country:US
Practice Address - Phone:787-884-6564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15640208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice