Healthcare Provider Details

I. General information

NPI: 1588184998
Provider Name (Legal Business Name): GLORYMAR OSTOLAZA VILLARRUBIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RIVERTOWN PLAZA 50 AVE LOS FILTROS LOCAL B
BAYAMON PR
00959
US

IV. Provider business mailing address

RIVERTOWN PLAZA 50 AVE LOS FILTROS LOCAL B
BAYAMON PR
00959
US

V. Phone/Fax

Practice location:
  • Phone: 787-798-5090
  • Fax: 787-785-5042
Mailing address:
  • Phone: 787-798-5090
  • Fax: 787-785-5042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number21023
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: