Basic Information
| Provider Information | |||||||||
| NPI: | 1346380128 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VILLALUZ | ||||||||
| FirstName: | LUCILA | ||||||||
| MiddleName: | QUINTO | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5349 | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180150349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4842219136 | ||||||||
| FaxNumber: | 4842219130 | ||||||||
| Practice Location | |||||||||
| Address1: | 865 E 4TH ST | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180151935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6706914357 | ||||||||
| FaxNumber: | 4842219130 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2007 | ||||||||
| LastUpdateDate: | 09/18/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | MD055156-L | PA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 018606 | 01 | PA | AMERIHEALTH 65 COMPLETE | OTHER | G80233 | 01 | PA | MAGELLAN BEHAVIORAL HEALT | OTHER | 018606 | 01 | PA | GATEWAY 65 COMPLETE | OTHER | 001621278 | 05 | PA | MEDICAID |