Healthcare Provider Details

I. General information

NPI: 1407901044
Provider Name (Legal Business Name): VIVIAN VILLARRUBIA VELEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 08/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE MATIENZO CINTRON #55
LUQUILLO PR
00773
US

IV. Provider business mailing address

PO BOX 1267
LUQUILLO PR
00773-1267
US

V. Phone/Fax

Practice location:
  • Phone: 787-889-5151
  • Fax: 787-889-5634
Mailing address:
  • Phone: 787-889-5151
  • Fax: 787-889-5634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number13106
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: