Healthcare Provider Details

I. General information

NPI: 1336541499
Provider Name (Legal Business Name): MARIAM SOFIA VILA-DELGADO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2014
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1114 AVE JESUS T PINERO
SAN JUAN PR
00921-1722
US

IV. Provider business mailing address

1114 AVE JESUS T PINERO
SAN JUAN PR
00921-1722
US

V. Phone/Fax

Practice location:
  • Phone: 787-781-3020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME144470
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number22125
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License Number22125
License Number StatePR
# 4
Primary TaxonomyY
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License Number22125
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: