Provider Demographics
NPI:1841290830
Name:EDWIN VILLAFANE & ANAMARIE FERRIOL
Entity type:Organization
Organization Name:EDWIN VILLAFANE & ANAMARIE FERRIOL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANAMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRIOL
Authorized Official - Suffix:
Authorized Official - Credentials:MSMTASCP
Authorized Official - Phone:787-787-3235
Mailing Address - Street 1:PO BOX 4115
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00958-1115
Mailing Address - Country:US
Mailing Address - Phone:787-787-3235
Mailing Address - Fax:787-780-4341
Practice Address - Street 1:E54 CALLE MARGINAL
Practice Address - Street 2:EXT FOREST HILLS
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-5513
Practice Address - Country:US
Practice Address - Phone:787-787-3235
Practice Address - Fax:787-780-4341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-30
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR654291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRPR00001000OtherSUBMITTER NUMBER