Provider Demographics
NPI:1366123986
Name:VILELLA LUGO, RAFAEL AYMAR
Entity type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:AYMAR
Last Name:VILELLA LUGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4637 CALLE LUNA APT 321
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-2047
Mailing Address - Country:US
Mailing Address - Phone:939-428-4759
Mailing Address - Fax:
Practice Address - Street 1:4637 CALLE LUNA APT 321
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-2047
Practice Address - Country:US
Practice Address - Phone:939-428-4759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR001098-P.A.363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical