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Individual
RAPHAEL VILLAVICENCIO
Active
Individual
RAPHAEL VILLAVICENCIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
01051969A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000351160
ANTHEM PROVIDER NUMBER
IN
05
—
200300450
—
IN
01
—
9397565
PHCS PID NUMBER
IN
Enumeration date
03/20/2006
Last updated
12/03/2010
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