Healthcare Provider Details

I. General information

NPI: 1740352160
Provider Name (Legal Business Name): GLORIA E COYA VILLARAOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 CALLE RUFINA
GUAYANILLA PR
00656-1720
US

IV. Provider business mailing address

PO BOX 7953
PONCE PR
00732
US

V. Phone/Fax

Practice location:
  • Phone: 787-835-2870
  • Fax: 787-835-2870
Mailing address:
  • Phone: 787-835-2870
  • Fax: 787-835-2870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number10791
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: