Provider Demographics
NPI:1356839062
Name:VILLAVICENCIO, JAIMY (MD)
Entity Type:Individual
Prefix:MISS
First Name:JAIMY
Middle Name:
Last Name:VILLAVICENCIO
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 1:100 ASYLUM AVENUE
Mailing Address - Street 2:SUITE 1004
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105
Mailing Address - Country:US
Mailing Address - Phone:860-714-4532
Mailing Address - Fax:860-714-8275
Practice Address - Street 1:100 ASYLUM AVENUE
Practice Address - Street 2:SUITE 1004
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105
Practice Address - Country:US
Practice Address - Phone:860-714-4532
Practice Address - Fax:860-714-8275
Is Sole Proprietor?:No
Enumeration Date:2018-04-27
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program