Healthcare Provider Details

I. General information

NPI: 1538117684
Provider Name (Legal Business Name): SALVADOR VILA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 PONCE DE LEON AVENUE SUITE 507
SAN JUAN PR
00917-5026
US

IV. Provider business mailing address

PO BOX 192349
SAN JUAN PR
00919-2349
US

V. Phone/Fax

Practice location:
  • Phone: 787-767-6340
  • Fax: 787-753-4935
Mailing address:
  • Phone: 787-793-8962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number7064
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: