Vernon Villanueva, PT
Individual provider Active NPI Physical Medicine & Rehabilitation Physician · Williamsburg, NM
NPI 1912445214 · NPPES record last updated Mar 8, 2018
Key facts
- NPI
- 1912445214
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Medicine & Rehabilitation Physician 208100000X
- License
- 4949 (NM)
- Practice address
- 720 Broadway St Apt 9
Williamsburg, NM 87942 - Phone
- (210) 544-4857
- NPI assigned
- Feb 7, 2017
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4949 | NM | MD | Physical Medicine & Rehabilitation Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician | 208100000X | 4949 | NM | Yes |
Addresses
Primary practice location
720 Broadway St Apt 9
Williamsburg, NM 87942
Mailing address
3530 Foothills Rd
Ste N
Las Cruces, NM 88011-3621
Phone (575) 532-6054
Other providers in Williamsburg, NM
All providers in Williamsburg, NM · Physical Medicine & Rehabilitation Physician in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 8, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.