1255531992 NPI number — DR. FERNANDO JOSE AVILES MD

Table of content: DR. FERNANDO JOSE AVILES MD (NPI 1255531992)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255531992 NPI number — DR. FERNANDO JOSE AVILES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AVILES
Provider First Name:
FERNANDO
Provider Middle Name:
JOSE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AVILES-CEVASCO
Provider Other First Name:
FERNANDO
Provider Other Middle Name:
JOSE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1255531992
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10412 VISTA DEL SOL DR STE 1B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79925-7937
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-593-9300
Provider Business Mailing Address Fax Number:
915-593-9310

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11450 GATEWAY BLVD N STE 2200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79934-3456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-440-3700
Provider Business Practice Location Address Fax Number:
915-440-3701
Provider Enumeration Date:
07/20/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 146D00000X , with the licence number:  N7210 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2300X , with the licence number: N7210 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: N7210 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)