Provider Demographics
NPI:1316051378
Name:JESSICA VILLAFANE PAGAN
Entity type:Organization
Organization Name:JESSICA VILLAFANE PAGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TECNOLOGA MEDICA
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLAFANE
Authorized Official - Suffix:
Authorized Official - Credentials:LCD
Authorized Official - Phone:787-871-0470
Mailing Address - Street 1:500 CARR 149 STE 6
Mailing Address - Street 2:
Mailing Address - City:CIALES
Mailing Address - State:PR
Mailing Address - Zip Code:00638-9661
Mailing Address - Country:US
Mailing Address - Phone:787-871-0470
Mailing Address - Fax:787-871-0470
Practice Address - Street 1:500 CARR 149 STE 6
Practice Address - Street 2:
Practice Address - City:CIALES
Practice Address - State:PR
Practice Address - Zip Code:00638-9661
Practice Address - Country:US
Practice Address - Phone:787-871-0470
Practice Address - Fax:787-871-0470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031406Medicare PIN