MEDICARE: MYRIAM VILLAFANA-SUAREZ 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	207RG0100X	Gastroenterology Physician	6106	PR

General Provider Information

NPI Number	:	1346234358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYRIAM VILLAFANA-SUAREZ MD

Provider Business Mailing Address
First Line	:	400 AVE FD ROOSEVELT
Second Line	:	STE 206
City	:	SAN JUAN
State	:	PR
Zip	:	00918-2103
Country	:	US
Telephone Number	:	787-764-8787
Fax Number	:	787-250-1029

Provider Business Practice Location Address
First Line	:	400 AVE FD ROOSEVELT
Second Line	:	STE 206
City	:	SAN JUAN
State	:	PR
Zip	:	00918-2103
Country	:	US
Telephone Number	:	787-764-8787
Fax Number	:	787-250-1029

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

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	06/13/2013

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