1376560896 NPI number — VILLAFLOR & VILLAFLOR A PROF CORP

Table of content: (NPI 1376560896)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376560896 NPI number — VILLAFLOR & VILLAFLOR A PROF CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VILLAFLOR & VILLAFLOR A PROF CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376560896
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3650 S EASTERN AVE
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89109-3379
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-796-4007
Provider Business Mailing Address Fax Number:
702-796-3993

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3650 S EASTERN AVE
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89109-3379
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-796-4007
Provider Business Practice Location Address Fax Number:
702-796-3993
Provider Enumeration Date:
07/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VILLAFLOR
Authorized Official First Name:
FLORENCE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
702-796-4007

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  NV6918 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2019595 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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