Provider Demographics
NPI:1134736911
Name:AVILES, CARLOS GABRIEL SR (DPT)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:GABRIEL
Last Name:AVILES
Suffix:SR
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1948 CALLE JOSE FIDALGO DIAZ APT 632
Mailing Address - Street 2:
Mailing Address - City:CUPEY
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5329
Mailing Address - Country:US
Mailing Address - Phone:787-702-2694
Mailing Address - Fax:
Practice Address - Street 1:1948 CALLE JOSE FIDALGO DIAZ APT 632
Practice Address - Street 2:
Practice Address - City:CUPEY
Practice Address - State:PR
Practice Address - Zip Code:00926-5329
Practice Address - Country:US
Practice Address - Phone:787-702-2694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-25
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4380225100000X
PR4580225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist