Provider Demographics
NPI:1174214951
Name:AVILES, PETER ALEXIS
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:ALEXIS
Last Name:AVILES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2857 S OASIS DR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8660
Mailing Address - Country:US
Mailing Address - Phone:561-319-4894
Mailing Address - Fax:
Practice Address - Street 1:931 VILLAGE BLVD STE 905-358
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-1803
Practice Address - Country:US
Practice Address - Phone:800-832-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
23-308363106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician