Healthcare Provider Details

I. General information

NPI: 1962463232
Provider Name (Legal Business Name): LUIS M. VILA-PEREZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 PONCE DE LEON AVE SUITE 507; COND. TORRE DE AUXILIO MUTUO
SAN JUAN PR
00917-5022
US

IV. Provider business mailing address

735 PONCE DE LEON AVE SUITE 507; COND. TORRE DE AUXILIO MUTUO
SAN JUAN PR
00917-5022
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number9238
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: