Provider Demographics
NPI:1952389025
Name:VILLAFANE CARMONA, LUCE
Entity type:Individual
Prefix:
First Name:LUCE
Middle Name:
Last Name:VILLAFANE CARMONA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 1210
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738
Mailing Address - Country:US
Mailing Address - Phone:787-863-2205
Mailing Address - Fax:787-860-2585
Practice Address - Street 1:UNION 46 A
Practice Address - Street 2:
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-863-2205
Practice Address - Fax:787-860-2585
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR35292084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E31127Medicare UPIN
93774Medicare ID - Type Unspecified