Provider Demographics
NPI:1821560566
Name:VILLEGAS, GUILLERMO JOSE (RN-BSN)
Entity Type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:JOSE
Last Name:VILLEGAS
Suffix:
Gender:M
Credentials:RN-BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PROFESSIONAL OFFICE PARK-BUILDING V PFIZER TOWER
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927
Mailing Address - Country:US
Mailing Address - Phone:787-641-9133
Mailing Address - Fax:
Practice Address - Street 1:EDIFICIO VIG TOWER AVE PONCE DE LEON#1225
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-723-4907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR88154163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4903472OtherDRIVER LIC.
PR88154OtherLIC. BSN-RN
PR4903472OtherREAL ID STATE