Provider Demographics
NPI:1538316971
Name:AVILES-BURGOS, YANIRA (MD)
Entity type:Individual
Prefix:
First Name:YANIRA
Middle Name:
Last Name:AVILES-BURGOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19325
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-1325
Mailing Address - Country:US
Mailing Address - Phone:787-518-5304
Mailing Address - Fax:787-936-7371
Practice Address - Street 1:1492 AVE PONCE DE LEON CENTRO EUROPA STE 104
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-0000
Practice Address - Country:US
Practice Address - Phone:787-518-5304
Practice Address - Fax:787-936-7371
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR018349207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GS899AMedicare PIN