Healthcare Provider Details

I. General information

NPI: 1710911342
Provider Name (Legal Business Name): FERNANDO VILLARINI M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. GAUTIER BENITEZ CONSOLIDATED MALL ANEXO B-5
CAGUAS PR
00725
US

IV. Provider business mailing address

1102 URB SERENNA
CAGUAS PR
00727-3300
US

V. Phone/Fax

Practice location:
  • Phone: 787-704-0705
  • Fax: 787-704-0870
Mailing address:
  • Phone: 787-374-9744
  • Fax: 787-704-0870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2315
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: