Healthcare Provider Details

I. General information

NPI: 1124097761
Provider Name (Legal Business Name): GUILLERMO VILA-SOTOMAYOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 45TH ST
WEST PALM BEACH FL
33407-2413
US

IV. Provider business mailing address

4961 ELSWORTH WAY
WEST PALM BEACH FL
33417-8227
US

V. Phone/Fax

Practice location:
  • Phone: 561-844-6300
  • Fax:
Mailing address:
  • Phone: 561-848-8701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME 59360
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: