Provider Demographics
NPI:1457467953
Name:VILLALBA, GRISSELLE I (MD)
Entity Type:Individual
Prefix:
First Name:GRISSELLE
Middle Name:I
Last Name:VILLALBA
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 1:208 CALLE SAN LORENZO
Mailing Address - Street 2:RIO PIEDRAS HEITHS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-3223
Mailing Address - Country:US
Mailing Address - Phone:787-751-0985
Mailing Address - Fax:
Practice Address - Street 1:208 CALLE SAN LORENZO
Practice Address - Street 2:RIO PIEDRAS HEITHS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-3223
Practice Address - Country:US
Practice Address - Phone:787-751-0985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12091146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR12091OtherLICENSE
PRH65838Medicare UPIN