Healthcare Provider Details

I. General information

NPI: 1306662887
Provider Name (Legal Business Name): HEIDY K VILLALBA URRUTIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2024
Last Update Date: 11/29/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8169 CALLE CONCORDIA CONDOMINIO SAN VICENTE STE 412
PONCE PR
00717
US

IV. Provider business mailing address

8169 CALLE CONCORDIA CONDOMINIO SAN VICENTE STE 412
PONCE PR
00717
US

V. Phone/Fax

Practice location:
  • Phone: 787-680-0236
  • Fax:
Mailing address:
  • Phone: 787-680-0236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: