Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XL0004X | Low Vision | 2559676 | NY |
NPI | 1124697156 |
---|---|
Provider Name | Deborah Evelise Aviles |
First Address | Bronx, NY 10454-1203 |
Second Address | Bronx, NY 10454-1203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2021 |
Last Update Date | 23/06/2021 |