Healthcare Provider Details

I. General information

NPI: 1619986767
Provider Name (Legal Business Name): IVONNE VILLAFANE-CANDELAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 09/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CENTRO MEDICO, CARR. 22 KM 2 CENTRO PEDIATRICO HOSPITAL PEDIATRICO UNIVERSITARIO
SAN JUAN PR
00935
US

IV. Provider business mailing address

PO BOX 190110
SAN JUAN PR
00919-0110
US

V. Phone/Fax

Practice location:
  • Phone: 787-763-0550
  • Fax: 787-763-1093
Mailing address:
  • Phone: 787-763-0550
  • Fax: 787-763-1093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number6356
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: