Provider Demographics
NPI:1245309244
Name:SEPULVEDA-VILLA, ILEANA (MD)
Entity type:Individual
Prefix:DR
First Name:ILEANA
Middle Name:
Last Name:SEPULVEDA-VILLA
Suffix:
Gender:F
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 5075
Mailing Address - Street 2:PMB 375
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-9809
Mailing Address - Country:US
Mailing Address - Phone:787-873-5359
Mailing Address - Fax:787-873-5359
Practice Address - Street 1:35 CALLE MATTEI LLUBERAS
Practice Address - Street 2:
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698-3638
Practice Address - Country:US
Practice Address - Phone:787-856-7708
Practice Address - Fax:787-856-7708
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0096042080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine