Basic Information
| Provider Information | |||||||||
| NPI: | 1235689142 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VILLANUEVA | ||||||||
| FirstName: | MAIRA | ||||||||
| MiddleName: | VERONICA | ||||||||
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| Credential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 7077 VISTA BLVD UNIT 5103 | ||||||||
| Address2: | |||||||||
| City: | SPARKS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894368026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7758578813 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3500 LAKESIDE CT STE 101 | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895094862 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757866880 | ||||||||
| FaxNumber: | 7757866899 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2016 | ||||||||
| LastUpdateDate: | 10/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.