Basic Information
Provider Information
NPI: 1033558507
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VILLANUEVA
FirstName: MARIA
MiddleName: VILLAGRANA
NamePrefix: MRS.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4956 HILDAGO WAY
Address2:  
City: LAS VEGAS
State: NV
PostalCode: 891212864
CountryCode: US
TelephoneNumber: 7027241516
FaxNumber:  
Practice Location
Address1: 3680 N RANCHO DR
Address2:  
City: LAS VEGAS
State: NV
PostalCode: 891303180
CountryCode: US
TelephoneNumber: 7028694300
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/18/2013
LastUpdateDate: 06/18/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103K00000X  Y Behavioral Health & Social Service ProvidersBehavioral Analyst 

No ID Information.


Home