# AMY V VILLAVICENCIO

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1629037098
- **Gender:** F
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 01060760A | IN | Yes |

## Other

- **Enumeration date:** 03/22/2006
- **Last updated:** 03/01/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000490525 | ANTHEM PROVIDER NUMBER | IN |
| 01 | — | 11492358 | CAQH NUMBER | IN |
| 05 | — | 200538780 | — | IN |
| 01 | — | 9397563 | PHCS PID NUMBER | IN |