MEDICARE: FERNANDO LUIS VILLAR FORNES MD

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	208D00000X	General Practice Physician	23418	PR

General Provider Information

NPI Number	:	1225719487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FERNANDO LUIS VILLAR FORNES MD

Provider Business Mailing Address
First Line	:	PO BOX 778 PUEBLO STATION
Second Line	:
City	:	CAROLINA
State	:	PR
Zip	:	00986
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	54 CALLE DE DIEGO N
Second Line	:
City	:	CAROLINA
State	:	PR
Zip	:	00985-6032
Country	:	US
Telephone Number	:	787-769-4528
Fax Number	:

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

Provider Enumeration Date	:	07/28/2023
Last Update Date	:	07/28/2023

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