Provider Demographics
NPI:1861615171
Name:COFRESI-AVILES, MARIAME (MD)
Entity type:Individual
Prefix:DR
First Name:MARIAME
Middle Name:
Last Name:COFRESI-AVILES
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 1:2323 S SHEPHERD DR
Mailing Address - Street 2:SUITE # 1106
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-7019
Mailing Address - Country:US
Mailing Address - Phone:713-523-8765
Mailing Address - Fax:713-942-0541
Practice Address - Street 1:2323 S SHEPHERD DR
Practice Address - Street 2:SUITE # 1106
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77019-7019
Practice Address - Country:US
Practice Address - Phone:713-523-8765
Practice Address - Fax:713-942-0541
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD81792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE04562Medicare UPIN