Healthcare Provider Details

I. General information

NPI: 1104833763
Provider Name (Legal Business Name): MAYRA ARLENE VILLAMIL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1479 CALLE ROBALO BAHIA VISTAMAR
CAROLINA PR
00983-1446
US

IV. Provider business mailing address

1479 CALLE ROBALO BAHIA VISTAMAR
CAROLINA PR
00983-1446
US

V. Phone/Fax

Practice location:
  • Phone: 787-752-4444
  • Fax: 787-752-4444
Mailing address:
  • Phone: 787-752-4444
  • Fax: 787-752-4444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number11211
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: