Individual
DR. MICHAEL R VILLANUEVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
837 ALDER CREEK DR, MEDFORD, OR 97504-8911
(541) 608-3878
(541) 608-3880
Mailing address
837 ALDER CREEK DR, MEDFORD, OR 97504-8911
(541) 608-3878
(541) 608-3880
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
0974
OR
103TC0700X
Clinical Psychologist
0974
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
042601
—
OR
Enumeration date
08/30/2006
Last updated
06/22/2010
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