Healthcare Provider Details

I. General information

NPI: 1457467953
Provider Name (Legal Business Name): GRISSELLE I VILLALBA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 CALLE SAN LORENZO RIO PIEDRAS HEITHS
SAN JUAN PR
00926-3223
US

IV. Provider business mailing address

208 CALLE SAN LORENZO RIO PIEDRAS HEITHS
SAN JUAN PR
00926-3223
US

V. Phone/Fax

Practice location:
  • Phone: 787-751-0985
  • Fax:
Mailing address:
  • Phone: 787-751-0985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number12091
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: