Provider Demographics
NPI:1871595694
Name:VILLANUEVA-BOSQUE, WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:VILLANUEVA-BOSQUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 140280
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-0280
Mailing Address - Country:US
Mailing Address - Phone:787-880-6122
Mailing Address - Fax:787-262-6298
Practice Address - Street 1:540 AVE MIRAMAR
Practice Address - Street 2:SUITE # 4
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4364
Practice Address - Country:US
Practice Address - Phone:787-880-6122
Practice Address - Fax:787-262-6298
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8400207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR81433Medicare ID - Type UnspecifiedPROVIDER ID OF MC CARRIER
PRE09387Medicare UPIN