Provider Demographics
NPI:1356392872
Name:SANTANA VILLEGAS, MARIA L (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:L
Last Name:SANTANA VILLEGAS
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:PO BOX 419
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-0419
Mailing Address - Country:US
Mailing Address - Phone:787-854-0934
Mailing Address - Fax:787-854-0934
Practice Address - Street 1:G13 MARGINAL
Practice Address - Street 2:URB. SAN SALVADOR
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-854-0934
Practice Address - Fax:787-854-0934
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4293174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4293OtherLICENSE #
PR4293OtherPEDIATRICIAN