Provider Demographics
NPI:1982809554
Name:VILLALTA, DORIS A (RN)
Entity Type:Individual
Prefix:MRS
First Name:DORIS
Middle Name:A
Last Name:VILLALTA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:STREET 4 NUMBER B7
Mailing Address - Street 2:HACIENDAS DE BORIQUEN
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-0000
Mailing Address - Country:US
Mailing Address - Phone:787-378-7068
Mailing Address - Fax:787-764-7004
Practice Address - Street 1:PEDIATRIC UNIVERSITY HOSPITAL THIRD FLOOR C
Practice Address - Street 2:MEDICAL CENTER
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936-0000
Practice Address - Country:US
Practice Address - Phone:787-777-3535
Practice Address - Fax:787-764-7004
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR016268163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR016268OtherREGISTER NURSE