Provider Demographics
NPI:1669166740
Name:VILLAFUERTE ROMERO, LUIS ANGEL
Entity type:Individual
Prefix:MR
First Name:LUIS
Middle Name:ANGEL
Last Name:VILLAFUERTE ROMERO
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 1:3850 N MISSISSIPPI AVE APT A225
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1351
Mailing Address - Country:US
Mailing Address - Phone:503-358-1714
Mailing Address - Fax:
Practice Address - Street 1:812 SW WASHINGTON ST STE 700
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-3200
Practice Address - Country:US
Practice Address - Phone:503-622-8964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health