Provider Demographics
NPI:1932763653
Name:AVILES, ROSA IRIS
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:IRIS
Last Name:AVILES
Suffix:
Gender:F
Credentials:
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 1570
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-1570
Mailing Address - Country:US
Mailing Address - Phone:787-833-8700
Mailing Address - Fax:787-265-5155
Practice Address - Street 1:1040 AVENIDA LOS CORAZONES CARR 2 INT BO SABALO
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00681-0068
Practice Address - Country:US
Practice Address - Phone:787-833-8700
Practice Address - Fax:787-265-5155
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR883225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist