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General NPI Number Information
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NPI Number | 1306272224
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Entity Type | Individual
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Provider Name | ELSIE L VILLANUEVA SAC
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Gender | Female
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Dates
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Enumeration Date | 09/24/2013
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Last Update Date | 09/24/2013
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Provider Practice Location Address
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Address Line | 654 CALLE JURIEL CIUDAD INTERAMERICANA
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City | BAYAMON
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State | PR
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Zip | 00956-6814
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Country | US
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Telephone | 787-349-8183
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Fax |
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Provider Business Mailing Address
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Address Line | GARDENIA ST. EXTENCION CAMPO ALEGRE B 3
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City | BAYAMON
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State | PR
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Zip | 00956
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Country | US
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Telephone | 787-349-8183
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1932
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License Number State | PR
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