1730147927 NPI number — DR. LYLKA RIOS AVILES OD

Table of content: DR. LYLKA RIOS AVILES OD (NPI 1730147927)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730147927 NPI number — DR. LYLKA RIOS AVILES OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIOS AVILES
Provider First Name:
LYLKA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
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:
1730147927
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/30/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
615 CARR 152
Provider Second Line Business Mailing Address:
SUITE 14
Provider Business Mailing Address City Name:
NARANJITO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00719-3808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-869-4242
Provider Business Mailing Address Fax Number:
787-869-2804

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
615 CARR 152
Provider Second Line Business Practice Location Address:
SUITE 14
Provider Business Practice Location Address City Name:
NARANJITO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00719-3808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-869-4242
Provider Business Practice Location Address Fax Number:
787-869-2804
Provider Enumeration Date:
05/04/2006

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: 152W00000X , with the licence number:  459 , 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)

  • Identifier: 215118 . This is a "PREFERRED HEALTH" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 890296 . This is a "MEDICARE Y MUCHO MAS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 58166 . This is a "TRIPLE S REFORMA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 2200093 . This is a "HUMANA REFORMA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 7695 . This is a "IMC (INT MED CARD)" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 077121 . This is a "CRUZ AZUL DE PUERTO RICO" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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