Active NPI
Naiomy Perez Villanueva
- Periodontics
- Vega Alta, PR
National Provider Identifier
1053814277
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 3305
- Practice address
- Carretera Estatal #2 KM 29.7
Vega Alta, PR 00692-6711 - Phone
- (787) 883-6560
- NPI assigned
- Mar 14, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 3305 | PR | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Student in an Organized Health Care Education/Training Program | 390200000X | 2952000752 | MI | |
| Periodontics | 1223P0300X | 3305 | MI | Primary |
Addresses
Primary practice location
Carretera Estatal #2 KM 29.7
Vega Alta, PR 00692-6711
Mailing address
3000 Calle Coral
Toa Baja, PR 00949-3047
Phone (787) 203-2097
Other practice location 1
2700 Martin Luther King Jr Blvd
Detroit, MI 48208-2576
Phone (313) 494-6611
Other practice location 2
20351 Beaconsfield St Apt 4
Harper Woods, MI 48225-1369
Phone (787) 203-2097
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3305 | PR | MD | Dentist |
| 3305 | MI | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1520985600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1731542400000",
"number": "1053814277",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3000 CALLE CORAL",
"city": "TOA BAJA",
"state": "PR",
"postal_code": "009493047",
"telephone_number": "787-203-2097"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "CARRETERA ESTATAL #2 KM 29.7",
"city": "VEGA ALTA",
"state": "PR",
"postal_code": "006926711",
"telephone_number": "787-883-6560"
}
],
"practiceLocations": [
{
"address_1": "2700 Martin Luther King Jr Blvd",
"address_purpose": "LOCATION",
"city": "Detroit",
"state": "MI",
"postal_code": "482082576",
"country_code": "US",
"telephone_number": "313-494-6611",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "20351 Beaconsfield St Apt 4",
"address_purpose": "LOCATION",
"city": "Harper Woods",
"state": "MI",
"postal_code": "482251369",
"country_code": "US",
"telephone_number": "787-203-2097",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PEREZ VILLANUEVA",
"first_name": "NAIOMY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-03-14",
"last_updated": "2024-11-14",
"certification_date": "2024-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "PR",
"license": "3305",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "MI",
"license": "2952000752",
"primary": false
},
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "MI",
"license": "3305",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Vega Alta, PR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.