Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 009604 | PR |
NPI | 1245309244 |
---|---|
Provider Name | Dr. Ileana Sepulveda-Villa |
First Address | San German, PR 00683-9809 |
Second Address | Yauco, PR 00698-3638 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 08/07/2007 |