Provider Demographics
NPI:1841340429
Name:VILLANUEVA, CARMEN MERCEDES (MD)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:MERCEDES
Last Name:VILLANUEVA
Suffix:
Gender:
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 3049
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-3049
Mailing Address - Country:US
Mailing Address - Phone:787-785-8034
Mailing Address - Fax:
Practice Address - Street 1:89 AVE DE DIEGO
Practice Address - Street 2:PMB 472 SUITE 105
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-6372
Practice Address - Country:US
Practice Address - Phone:787-318-2584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR141572085N0700X, 2085R0202X
VA01012839192085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology