Provider Demographics
NPI:1811054901
Name:AVILES-RIBOT, OSVALDO (MD)
Entity type:Individual
Prefix:
First Name:OSVALDO
Middle Name:
Last Name:AVILES-RIBOT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6675 WESTWOOD BLVD
Mailing Address - Street 2:STE 475
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-6027
Mailing Address - Country:US
Mailing Address - Phone:407-845-0330
Mailing Address - Fax:888-972-1752
Practice Address - Street 1:1918 BLANDING BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-3202
Practice Address - Country:US
Practice Address - Phone:305-278-0200
Practice Address - Fax:305-851-4110
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10493208D00000X
FLACN539208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRAV82668OtherSSS NUMBER, INSURANCE PLA
PRF28874Medicare UPIN
PR82668Medicare ID - Type Unspecified