Provider Demographics
NPI:1669547717
Name:MALDONADO AVILES, ILDALY (MD)
Entity type:Individual
Prefix:DR
First Name:ILDALY
Middle Name:
Last Name:MALDONADO 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 2072
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-2072
Mailing Address - Country:US
Mailing Address - Phone:787-872-6200
Mailing Address - Fax:787-872-6200
Practice Address - Street 1:CARR 113 ESQ CARR 474 KM 0 BARRIO COTO
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-0001
Practice Address - Country:US
Practice Address - Phone:787-872-6200
Practice Address - Fax:787-872-6200
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15571208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0022953Medicare ID - Type UnspecifiedM.D
PRI-29190Medicare UPIN