Healthcare Provider Details

I. General information

NPI: 1013988815
Provider Name (Legal Business Name): RAUL G VILA RAMIREZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 04/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 AVE PONCE DE LEON SUITE 407
SAN JUAN PR
00917-5022
US

IV. Provider business mailing address

735 AVE PONCE DE LEON SUITE 407
SAN JUAN PR
00917-5022
US

V. Phone/Fax

Practice location:
  • Phone: 787-773-0533
  • Fax: 787-773-0534
Mailing address:
  • Phone: 787-773-0533
  • Fax: 787-773-0534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number13276
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: