Provider Demographics
NPI:1780147447
Name:AVILES, RAUL (DPM)
Entity type:Individual
Prefix:
First Name:RAUL
Middle Name:
Last Name:AVILES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 INDIAN WELLS RD STE A
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-4611
Mailing Address - Country:US
Mailing Address - Phone:575-434-0639
Mailing Address - Fax:575-434-4148
Practice Address - Street 1:2301 INDIAN WELLS RD STE A
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-4611
Practice Address - Country:US
Practice Address - Phone:575-434-0639
Practice Address - Fax:575-434-4148
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NMPOD456213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program