1245309244 NPI number — DR. ILEANA SEPULVEDA-VILLA M.D.

Table of content: DR. ILEANA SEPULVEDA-VILLA M.D. (NPI 1245309244)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245309244 NPI number — DR. ILEANA SEPULVEDA-VILLA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEPULVEDA-VILLA
Provider First Name:
ILEANA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245309244
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5075
Provider Second Line Business Mailing Address:
PMB 375
Provider Business Mailing Address City Name:
SAN GERMAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00683-9809
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-873-5359
Provider Business Mailing Address Fax Number:
787-873-5359

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35 CALLE MATTEI LLUBERAS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YAUCO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00698-3638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-856-7708
Provider Business Practice Location Address Fax Number:
787-856-7708
Provider Enumeration Date:
11/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080A0000X , with the licence number:  009604 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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