1679558050 NPI number — VILLA ALBA CORPORATION

Table of content: (NPI 1679558050)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679558050 NPI number — VILLA ALBA CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VILLA ALBA CORPORATION
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:
1679558050
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 790
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85211-0790
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-726-7773
Provider Business Mailing Address Fax Number:
480-726-7790

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1212 N. SPENCER ST.
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-726-6553
Provider Business Practice Location Address Fax Number:
480-726-3329
Provider Enumeration Date:
12/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
TEJADA
Authorized Official First Name:
CHRISTINE
Authorized Official Middle Name:
VILLARAZA
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
480-726-7773

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  HSPC3710 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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