Provider Demographics
NPI:1689609745
Name:SIERRA, VILMARY (MD)
Entity Type:Individual
Prefix:
First Name:VILMARY
Middle Name:
Last Name:SIERRA
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:K27 CALLE 16
Mailing Address - Street 2:URB.METROPOLIS
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-7446
Mailing Address - Country:US
Mailing Address - Phone:787-619-3636
Mailing Address - Fax:787-257-8188
Practice Address - Street 1:CALLE79 BLQ 120-19
Practice Address - Street 2:URB.VILLA CAROLINA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-257-8188
Practice Address - Fax:787-257-8188
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15002208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI-05515Medicare UPIN