Provider Demographics
NPI:1013392778
Name:MAYRA VILLANUEVA PAGAN
Entity Type:Organization
Organization Name:MAYRA VILLANUEVA PAGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAYRA
Authorized Official - Middle Name:EDNA
Authorized Official - Last Name:VILLANUEVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-689-0665
Mailing Address - Street 1:HC 56 BOX 47773
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-8706
Mailing Address - Country:US
Mailing Address - Phone:787-689-0665
Mailing Address - Fax:
Practice Address - Street 1:HC 56 BOX 47773
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-8706
Practice Address - Country:US
Practice Address - Phone:787-689-0665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10647302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization