Provider Demographics
NPI:1699371484
Name:VILLEGAS, JESLY (MD)
Entity Type:Individual
Prefix:
First Name:JESLY
Middle Name:
Last Name:VILLEGAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JESLY
Other - Middle Name:
Other - Last Name:VILLEGAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:URB PRADERAS DEL RIO 3028
Mailing Address - Street 2:CALLE RIO BUCANA
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953
Mailing Address - Country:US
Mailing Address - Phone:787-279-3632
Mailing Address - Fax:
Practice Address - Street 1:CARR 829 KM 1.8
Practice Address - Street 2:BO PINAS
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953
Practice Address - Country:US
Practice Address - Phone:787-279-3632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23470208D00000X
PR390200000X
PR609PA363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program