Individual
DR. IDALIA TALAVERA-AVILES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1200 N UNIVERSITY DR, PLANTATION, FL 33322-4724
(954) 791-3090
(954) 791-3166
Mailing address
1200 N UNIVERSITY DR, PLANTATION, FL 33322-4724
(954) 791-3090
(954) 791-3166
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
ME85186
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
266388100
—
FL
01
—
29049
BCBS PROVIDER NUMBER
FL
01
—
29049Z
GROUP MEDICARE PIN
FL
01
—
542129332
TAX ID
FL
01
—
7953427
AETNA PROVIDER NUMBER
FL
Enumeration date
06/03/2006
Last updated
05/15/2014
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