Provider Demographics
NPI:1508025750
Name:VILLEGAS PELAEZ, LINA M (MD)
Entity Type:Individual
Prefix:DR
First Name:LINA
Middle Name:M
Last Name:VILLEGAS PELAEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:314 12TH ST APT 6
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-6787
Mailing Address - Country:US
Mailing Address - Phone:646-775-7756
Mailing Address - Fax:
Practice Address - Street 1:250 BALTIC ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-6401
Practice Address - Country:US
Practice Address - Phone:718-855-3131
Practice Address - Fax:718-855-4011
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2021-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2670782084P0800X
NY15080257502084P0800X
NY0037022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY267078OtherNYS LICENSE