Provider Demographics
NPI:1679174098
Name:ADAMES VILLAMIL, FABIOLA TATIANA
Entity type:Individual
Prefix:
First Name:FABIOLA
Middle Name:TATIANA
Last Name:ADAMES VILLAMIL
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 1:111 MGNL DE ROOSEVELT
Mailing Address - Street 2:14A
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-2713
Mailing Address - Country:US
Mailing Address - Phone:787-420-6868
Mailing Address - Fax:
Practice Address - Street 1:111 MGNL DE ROOSEVELT
Practice Address - Street 2:14A
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-2713
Practice Address - Country:US
Practice Address - Phone:787-420-6868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6604103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling