Basic Information
| Provider Information | |||||||||
| NPI: | 1184918039 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VILLANUEVA | ||||||||
| FirstName: | MARIE BERNADETTE | ||||||||
| MiddleName: | SABANAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1501 N CAMPBELL AVE RM 6336 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857240001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206262760 | ||||||||
| FaxNumber: | 5206266020 | ||||||||
| Practice Location | |||||||||
| Address1: | 1501 N CAMPBELL AVE RM 6336 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857246204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206262760 | ||||||||
| FaxNumber: | 5206266020 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2011 | ||||||||
| LastUpdateDate: | 06/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 390200000X | AZ | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | R78683 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.