Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 226375 | MA |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 226375 | MA |
NPI | 1184732919 |
---|---|
Provider Name | Jorge Arturo Villafuerte Vallejos |
First Address | Waltham, MA 02451-7118 |
Second Address | Boston, MA 02130-4817 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 24/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
226375 | FULL MEDICAL LICENSE (01) | MA |