Provider Demographics
NPI:1801061981
Name:ROMAN VILLANUEVA, MIGUEL A (MD)
Entity type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:A
Last Name:ROMAN VILLANUEVA
Suffix:
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:PO BOX 907
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-0907
Mailing Address - Country:US
Mailing Address - Phone:787-898-4190
Mailing Address - Fax:787-262-3984
Practice Address - Street 1:CARR #2 KM 86.6 INT MARGINAL NORTE
Practice Address - Street 2:
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659-1847
Practice Address - Country:US
Practice Address - Phone:787-898-4190
Practice Address - Fax:787-898-3619
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17126208D00000X
PR20339261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice