MEDICARE: FERNANDO BORDET VILLA M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	11267	PR

General Provider Information

NPI Number	:	1134114705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FERNANDO BORDET VILLA M.D

Provider Business Mailing Address
First Line	:	1659 CALLE JOSE H CORA
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00909-2932
Country	:	US
Telephone Number	:	787-727-8085
Fax Number	:

Provider Business Practice Location Address
First Line	:	41A CALLE ORQUIDEA
Second Line	:
City	:	CANOVANAS
State	:	PR
Zip	:	00729-3540
Country	:	US
Telephone Number	:	787-256-5659
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	12/04/2009

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