Provider Demographics
NPI:1396795563
Name:ISLA LLAMAS, JAVIER E SR (MD)
Entity type:Individual
Prefix:DR
First Name:JAVIER
Middle Name:E
Last Name:ISLA LLAMAS
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CALLE ROSANTA AULET
Mailing Address - Street 2:
Mailing Address - City:JAYUYA
Mailing Address - State:PR
Mailing Address - Zip Code:00664-1328
Mailing Address - Country:US
Mailing Address - Phone:787-828-0305
Mailing Address - Fax:787-828-0901
Practice Address - Street 1:2 CALLE ROSANTA AULET
Practice Address - Street 2:
Practice Address - City:JAYUYA
Practice Address - State:PR
Practice Address - Zip Code:00664-1328
Practice Address - Country:US
Practice Address - Phone:787-828-0503
Practice Address - Fax:787-828-0901
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13280208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
H55635Medicare UPIN
PR0080285Medicare ID - Type Unspecified