Basic Information
| Provider Information | |||||||||
| NPI: | 1467868927 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AVILA ORNELAS | ||||||||
| FirstName: | JOSE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 718 CALLE FRAY A MARCHENA | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009267727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877540101 | ||||||||
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| Practice Location | |||||||||
| Address1: | UNIVERSITY DISTRICT HOSPITAL | ||||||||
| Address2: | PUERTO RICO MEDICAL CENTER, BO MONACILLOS | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877540101 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2014 | ||||||||
| LastUpdateDate: | 08/10/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 19904 | PR | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.