Provider Demographics
NPI:1578657151
Name:VILLAVICENCIO, RAFAEL E (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:E
Last Name:VILLAVICENCIO
Suffix:
Gender:M
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 FD ROOSEVELT AVE CLINICA LAS AMERICA
Mailing Address - Street 2:SUITE # 510
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936
Mailing Address - Country:US
Mailing Address - Phone:787-764-3240
Mailing Address - Fax:
Practice Address - Street 1:400 FD ROOSEVELT AVE CLINICA LAS AMERICA
Practice Address - Street 2:SUITE # 510
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936
Practice Address - Country:US
Practice Address - Phone:787-764-3240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13438174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist