Provider Demographics
NPI:1417061474
Name:VILLAFANE PAGAN, JESSICA (LCD)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:VILLAFANE PAGAN
Suffix:
Gender:F
Credentials:LCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CARR 149 STE 2
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 2
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031406Medicare ID - Type UnspecifiedPROVEEDOR