Provider Demographics
NPI:1336819663
Name:VILLANUEVA, KEILA MARI
Entity type:Individual
Prefix:
First Name:KEILA
Middle Name:MARI
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. NUEVO SAN ANTONIO
Mailing Address - Street 2:311 CALLE AGUACATE
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00690
Mailing Address - Country:US
Mailing Address - Phone:787-629-3721
Mailing Address - Fax:
Practice Address - Street 1:CARR 459 KM 11.9 BO JOBOS
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00672
Practice Address - Country:US
Practice Address - Phone:787-872-4343
Practice Address - Fax:787-872-4430
Is Sole Proprietor?:No
Enumeration Date:2021-09-17
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8019183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist