Provider Demographics
NPI:1679169874
Name:BERMEO VILLACIS, BEATRIZ A (MD)
Entity type:Individual
Prefix:DR
First Name:BEATRIZ
Middle Name:A
Last Name:BERMEO VILLACIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BEATRIZ
Other - Middle Name:ARACELY
Other - Last Name:BERMEO MONCAYO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:CIUDADELA BELLAVISTA
Mailing Address - Street 2:
Mailing Address - City:GUAYAQUIL
Mailing Address - State:GUAYAS
Mailing Address - Zip Code:090603
Mailing Address - Country:EC
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CIUDADELA BELLAVISTA
Practice Address - Street 2:
Practice Address - City:GUAYAQUIL
Practice Address - State:GUAYAS
Practice Address - Zip Code:090603
Practice Address - Country:EC
Practice Address - Phone:305-305-3055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-12
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL111111207WX0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases SpecialistGroup - Single Specialty