Basic Information
| Provider Information | |||||||||
| NPI: | 1245783034 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AVILES BURGOS MEDICAL GROUP & HOSPITALIST SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 19325 | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009101325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877213444 | ||||||||
| FaxNumber: | 7877213458 | ||||||||
| Practice Location | |||||||||
| Address1: | 1399 CALLE FERIA | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009092519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7875185304 | ||||||||
| FaxNumber: | 7877213458 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2016 | ||||||||
| LastUpdateDate: | 07/27/2016 | ||||||||
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| AuthorizedOfficialLastName: | AVILES | ||||||||
| AuthorizedOfficialFirstName: | YANIRA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7877213444 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 311203 | 01 | PR | REGISTRO | OTHER |