1245470897 NPI number — DR. LEGNA JENNIS OTERO VILLAFANE I PSY.D

Table of content: DR. LEGNA JENNIS OTERO VILLAFANE I PSY.D (NPI 1245470897)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245470897 NPI number — DR. LEGNA JENNIS OTERO VILLAFANE I PSY.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OTERO VILLAFANE
Provider First Name:
LEGNA
Provider Middle Name:
JENNIS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
I
Provider Credential Text:
PSY.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:
1245470897
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 371029
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAYEY
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00737-1029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-595-9682
Provider Business Mailing Address Fax Number:
787-687-5745

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
URB. PRADERAS DE NAVARRO
Provider Second Line Business Practice Location Address:
C 22 T8
Provider Business Practice Location Address City Name:
GURABO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00778
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-595-9682
Provider Business Practice Location Address Fax Number:
787-687-5745
Provider Enumeration Date:
02/23/2009

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: 103TC0700X , with the licence number:  3274 , 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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