Healthcare Provider Details

I. General information

NPI: 1821560566
Provider Name (Legal Business Name): GUILLERMO JOSE VILLEGAS RN-BSN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2018
Last Update Date: 12/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EDIFICIO VIG TOWER AVE PONCE DE LEON#1225
SAN JUAN PR
00907
US

IV. Provider business mailing address

PROFESSIONAL OFFICE PARK-BUILDING V PFIZER TOWER
SAN JUAN PR
00927
US

V. Phone/Fax

Practice location:
  • Phone: 787-723-4907
  • Fax:
Mailing address:
  • Phone: 787-641-9133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number88154
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: