Healthcare Provider Details

I. General information

NPI: 1568357135
Provider Name (Legal Business Name): AMALEK VILLANELLE GIRALD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: AMALEK V. GIRALD

II. Dates (important events)

Enumeration Date: 06/12/2025
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSIDAD CARLOS ALBIZU, 151 CA. DE LA TANCA
SAN JUAN PR
00901
US

IV. Provider business mailing address

CALLE MAGNOLIA APT 3
SAN JUAN PR
00915
US

V. Phone/Fax

Practice location:
  • Phone: 787-725-6500
  • Fax:
Mailing address:
  • Phone: 787-908-3430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: