Healthcare Provider Details

I. General information

NPI: 1932309895
Provider Name (Legal Business Name): VILLA LOS SANTOS ADVANTAGE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB VILLA LOS SANTOS CALLE 16 V 1
ARECIBO PR
00612
US

IV. Provider business mailing address

PO BOX 9091 COTTO STATION
ARECIBO PR
00613-9091
US

V. Phone/Fax

Practice location:
  • Phone: 787-817-3144
  • Fax: 787-879-4315
Mailing address:
  • Phone: 787-878-3144
  • Fax: 787-879-4315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARIA J GONZALEZ
Title or Position: ADMINISTRADORA
Credential: M.D.
Phone: 787-817-3144