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Individual
IDA Z VILLANUEVA
Active
Individual
IDA Z VILLANUEVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
12015
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0048917000
—
WV
05
—
14867
—
WV
01
—
205832
CARELINK
—
01
—
288986
UNITEDHEALTHCARE
—
05
—
A12015
—
WV
01
—
D49309
HEALTH NET
—
Enumeration date
10/03/2006
Last updated
07/17/2007
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