Individual
DANIEL RENE VILLELA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SUBMARINE IDC
Contact information
Practice address
166 ARROWOOD DR, GROTON, CT 06340-2509
(912) 506-8705
Mailing address
166 ARROWOOD DR, GROTON, CT 06340-2509
(912) 506-8705
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B66179906
VIRGINIA
VA
Enumeration date
03/23/2021
Last updated
03/23/2021
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