1215205141 NPI number — DR. THELMA CALO VILLANUEVA M.D.

Table of content: DR. THELMA CALO VILLANUEVA M.D. (NPI 1215205141)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215205141 NPI number — DR. THELMA CALO VILLANUEVA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VILLANUEVA
Provider First Name:
THELMA
Provider Middle Name:
CALO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VILLANUEVA
Provider Other First Name:
THELMA
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1215205141
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
408 W CRANE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTON
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67654-1122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-472-7509
Provider Business Mailing Address Fax Number:
914-472-7509

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
408 W CRANE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67654-1122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-472-7509
Provider Business Practice Location Address Fax Number:
914-472-7509
Provider Enumeration Date:
12/07/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  04-31737 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RN0300X , with the licence number: 04-31737 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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