=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568992030
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILFREDO AUSTIN VILLARRUBIA PA-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2017
-----------------------------------------------------
Last Update Date | 03/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 146 E HOSPITAL DR STE 550
-----------------------------------------------------
City | WEST COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29169-4843
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-936-7140
-----------------------------------------------------
Fax | 803-936-7412
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1100 LONG POND ROAD SUITE 250
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14626-4122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-368-4350
-----------------------------------------------------
Fax | 585-227-7324
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | 020884
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | 4990
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------