Healthcare Provider Details

I. General information

NPI: 1750190401
Provider Name (Legal Business Name): MR. BENJAMIN ABDIEL VILLEGAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2025
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 19 CONDOMINIO CAMINO REAL 1500 APT E-103
GUAYNABO PR
00966-0000
US

IV. Provider business mailing address

CARR 19 CONDOMINIO CAMINO REAL 1500 APT E-103
GUAYNABO PR
00966-0000
US

V. Phone/Fax

Practice location:
  • Phone: 787-445-0101
  • Fax:
Mailing address:
  • Phone: 787-445-0101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number8322
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: