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General NPI Number Information
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NPI Number | 1821122656
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Entity Type | Individual
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Provider Name | IDA LUZ VILLA PASTOR MD
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Gender | Female
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 09/07/2010
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Provider Practice Location Address
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Address Line | MENDEZ VIGO 410 SUITE 204
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City | DORADO
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State | PR
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Zip | 00646
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Country | US
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Telephone | 787-796-1464
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Fax | 787-278-3338
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Provider Business Mailing Address
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Address Line | VILLAS DE PLAYA I URB DORADO DEL MAR APT N 1
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City | DORADO
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State | PR
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Zip | 00646
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Country | US
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Telephone | 787-796-4523
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 9748
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License Number State | PR
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