Individual
MARISOL VILLACIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
516 E NIZHONI BLVD, GALLUP, NM 87301-5748
(505) 722-1790
Mailing address
15105 SW 109TH ST, MIAMI, FL 33196-4347
(786) 282-8177
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
Primary
9256240
FL
Other
Enumeration date
06/15/2020
Last updated
06/15/2020
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