Provider Demographics
NPI:1841403714
Name:AVILES, ALICIA VEGA (RN)
Entity type:Individual
Prefix:MISS
First Name:ALICIA
Middle Name:VEGA
Last Name:AVILES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:ALICIA
Other - Middle Name:VEGA
Other - Last Name:AVILES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:CALLE 7 2QL #213
Mailing Address - Street 2:VILLA FONTANA
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983
Mailing Address - Country:US
Mailing Address - Phone:787-614-7917
Mailing Address - Fax:787-763-7515
Practice Address - Street 1:CALLE 7 2QL 213
Practice Address - Street 2:VILLA FONTANA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:787-614-7917
Practice Address - Fax:787-763-7515
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR336163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR336OtherR.N