Basic Information
Provider Information | |||||||||
NPI: | 1710911342 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | VILLARINI | ||||||||
FirstName: | FERNANDO | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | MR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.A. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1102 URB SERENNA | ||||||||
Address2: |   | ||||||||
City: | CAGUAS | ||||||||
State: | PR | ||||||||
PostalCode: | 007273300 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7873749744 | ||||||||
FaxNumber: | 7877040870 | ||||||||
Practice Location | |||||||||
Address1: | AVE. GAUTIER BENITEZ CONSOLIDATED MALL ANEXO B-5 | ||||||||
Address2: |   | ||||||||
City: | CAGUAS | ||||||||
State: | PR | ||||||||
PostalCode: | 00725 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7877040705 | ||||||||
FaxNumber: | 7877040870 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/10/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC1900X | 2315 | PR | Y |   | Behavioral Health & Social Service Providers | Psychologist | Counseling |
No ID Information.