1851682801 NPI number — DR. BOLIVAR A. VILLACIS BERMEO MD

Table of content: DR. BOLIVAR A. VILLACIS BERMEO MD (NPI 1851682801)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851682801 NPI number — DR. BOLIVAR A. VILLACIS BERMEO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VILLACIS BERMEO
Provider First Name:
BOLIVAR
Provider Middle Name:
A.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1851682801
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PADRE SOLANO 1311 Y GARCIA MORENO
Provider Second Line Business Mailing Address:
EDIFICIO ANVIED, PRIMER PISO, OFICINAS 1 Y 2
Provider Business Mailing Address City Name:
GUAYAQUIL
Provider Business Mailing Address State Name:
GUAYAS
Provider Business Mailing Address Postal Code:
090514
Provider Business Mailing Address Country Code:
EC
Provider Business Mailing Address Telephone Number:
59342290931
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PADRE SOLANO 1311 Y GARCIA MORENO
Provider Second Line Business Practice Location Address:
EDIFICIO ANVIED, PRIMER PISO, OFICINAS 1 Y 2
Provider Business Practice Location Address City Name:
GUAYAQUIL
Provider Business Practice Location Address State Name:
GUAYAS
Provider Business Practice Location Address Postal Code:
090514
Provider Business Practice Location Address Country Code:
EC
Provider Business Practice Location Address Telephone Number:
59342290931
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/26/2011

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: 208600000X , with the licence number:  5625 , registered in the state of ZZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 390200000X , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X , with the licence number: 2499 , registered in the state of ZZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X , registered in the state of ZZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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