Provider Demographics
NPI:1659310167
Name:AVILES, VICTOR ANIBAL (PSYD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:ANIBAL
Last Name:AVILES
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 CALLE SANTA CRUZ
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-6953
Mailing Address - Country:US
Mailing Address - Phone:787-523-4315
Mailing Address - Fax:
Practice Address - Street 1:59 CALLE SANTA CRUZ
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6953
Practice Address - Country:US
Practice Address - Phone:787-523-4315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR53401041C0700X
PR2721103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical