Individual provider Active NPI

Naiomy Perez Villanueva

  • Periodontics
  • Vega Alta, PR
National Provider Identifier
1053814277
Registry record updated Nov 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
3305 Issued in MI
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

Updated by the provider on Nov 14, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
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

LicenseStateTypeSpecialty
3305PRMDDentist
3305MIMDPeriodontist

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.

Verify at the official NPI Registry.