Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 15362-I | PR |
NPI | 1043837628 |
---|---|
Provider Name | Dr. Roy Enrique Villafane |
First Address | Vega Alta, PR 00692 |
Second Address | Manati, PR 00674 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2020 |
Last Update Date | 30/06/2020 |