Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 14610 | PR |
Y | 111NI0900X | Internist | 14610 | PR |
N | 207RG0300X | Geriatric Medicine | 14610 | PR |
NPI | 1164417630 |
---|---|
Provider Name | Dr. Alberto Rene Villanueva |
First Address | San Juan, PR 00933-3034 |
Second Address | San Juan, PR 00921-3200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2005 |
Last Update Date | 29/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I-45952 | (02) | PR |