Provider Demographics
NPI:1356583777
Name:AMARILIS AVILES-GARCIA MD PA
Entity type:Organization
Organization Name:AMARILIS AVILES-GARCIA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMARILIS
Authorized Official - Middle Name:
Authorized Official - Last Name:AVILES-GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-326-0596
Mailing Address - Street 1:800 ZEAGLER DR
Mailing Address - Street 2:SUITE 430
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-3883
Mailing Address - Country:US
Mailing Address - Phone:386-326-0596
Mailing Address - Fax:386-326-0598
Practice Address - Street 1:800 ZEAGLER DR
Practice Address - Street 2:SUITE 430
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-3883
Practice Address - Country:US
Practice Address - Phone:386-326-0596
Practice Address - Fax:386-326-0598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-31
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102471207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicaid
FLPENDINGMedicare PIN