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Individual

RAUL LUIS VILCA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
12510 QUEENS BLVD, KEW GARDENS, NY 11415-1519
(718) 261-0444
(718) 261-0940
Mailing address
PO BOX 9608, UNIONDALE, NY 11555-9608
(718) 261-0444
(718) 261-0940

Taxonomy

Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
41816
KY
207RI0011X
Interventional Cardiology Physician
Primary
41816
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000584955
BCBS
KY
01
265821
LICENSE NUMBER
NY
05
7100055030
KY
Enumeration date
06/03/2008
Last updated
11/16/2012
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