Provider Demographics
NPI:1518103522
Name:VILLAVICENCIO-CAMACHO&CO.,PEDIATRIC CARDIOLOGY ASSOCIATES PSC
Entity Type:Organization
Organization Name:VILLAVICENCIO-CAMACHO&CO.,PEDIATRIC CARDIOLOGY ASSOCIATES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:VILLAVICENCIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-764-3240
Mailing Address - Street 1:PO BOX 360894
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-0894
Mailing Address - Country:US
Mailing Address - Phone:787-764-3240
Mailing Address - Fax:787-751-9470
Practice Address - Street 1:400 AVE FRANKLIN D ROOSEVELT
Practice Address - Street 2:SUITE 510
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2103
Practice Address - Country:US
Practice Address - Phone:787-765-1919
Practice Address - Fax:787-765-1918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-22
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13438261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center