Provider Demographics
NPI:1700165560
Name:AVILES-REYES, CARLOS (PHD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:
Last Name:AVILES-REYES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BO. LOMAS K.1.9
Mailing Address - Street 2:P.O.BOX 2051
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-2051
Mailing Address - Country:US
Mailing Address - Phone:787-949-7369
Mailing Address - Fax:787-355-7802
Practice Address - Street 1:URB. PAISAJE DEL RIO
Practice Address - Street 2:CALLE C-6
Practice Address - City:LUQUILLO
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00773
Practice Address - Country:UM
Practice Address - Phone:787-949-7369
Practice Address - Fax:787-355-7802
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1434103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical