Provider Demographics
NPI:1346234358
Name:VILLAFANA-SUAREZ, MYRIAM (MD)
Entity Type:Individual
Prefix:
First Name:MYRIAM
Middle Name:
Last Name:VILLAFANA-SUAREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 AVE FD ROOSEVELT
Mailing Address - Street 2:STE 206
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-2103
Mailing Address - Country:US
Mailing Address - Phone:787-764-8787
Mailing Address - Fax:787-250-1029
Practice Address - Street 1:400 AVE FD ROOSEVELT
Practice Address - Street 2:STE 206
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2103
Practice Address - Country:US
Practice Address - Phone:787-764-8787
Practice Address - Fax:787-250-1029
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6106207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR24118CMedicare ID - Type Unspecified