Provider Demographics
NPI:1639179633
Name:VILLAFANE SAN INOCENCIO, EDWIN (MD)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:
Last Name:VILLAFANE SAN INOCENCIO
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:PO BOX 4115
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00958-1115
Mailing Address - Country:US
Mailing Address - Phone:787-780-4341
Mailing Address - Fax:787-780-4341
Practice Address - Street 1:E54 CALLE MARGINAL
Practice Address - Street 2:EXT FOREST HILLS
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-5513
Practice Address - Country:US
Practice Address - Phone:787-780-4341
Practice Address - Fax:787-780-4341
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5447207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRPR00001000OtherSUBMITTER NUMBER
PRPR00001000OtherSUBMITTER NUMBER