Provider Demographics
NPI:1760182547
Name:VILLAFANE-ORTIZ, WILFREDO JESUS
Entity Type:Individual
Prefix:
First Name:WILFREDO
Middle Name:JESUS
Last Name:VILLAFANE-ORTIZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EST. TALAVERA 1
Mailing Address - Street 2:7756 CALLE TUCAN
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-4870
Mailing Address - Country:US
Mailing Address - Phone:787-366-7813
Mailing Address - Fax:
Practice Address - Street 1:PASEO DR JOSE CELSO BARBOSA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-758-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-09
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program