1669547717 NPI number — DR. ILDALY MALDONADO AVILES M.D.

Table of content: DR. ILDALY MALDONADO AVILES M.D. (NPI 1669547717)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669547717 NPI number — DR. ILDALY MALDONADO AVILES M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MALDONADO AVILES
Provider First Name:
ILDALY
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669547717
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2072
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ISABELA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00662-2072
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-872-6200
Provider Business Mailing Address Fax Number:
787-872-6200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 113 ESQ CARR 474 KM 0 BARRIO COTO
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ISABELA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00662-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-872-6200
Provider Business Practice Location Address Fax Number:
787-872-6200
Provider Enumeration Date:
11/22/2006

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: 208D00000X , with the licence number:  15571 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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