Healthcare Provider Details

I. General information

NPI: 1336291053
Provider Name (Legal Business Name): HECTOR LUIS VILLANUEVA RODRIGUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 04/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 AVE BORINQUEN
SAN JUAN PR
00915-3822
US

IV. Provider business mailing address

ELEMIR 101 ALTURAS DE SANTA MARIA
GUAYNABO PR
00969-4722
US

V. Phone/Fax

Practice location:
  • Phone: 787-268-4171
  • Fax: 787-727-3695
Mailing address:
  • Phone: 787-378-9879
  • Fax: 787-727-3695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number8218
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: