Individual
JAY VILLANUEVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3710 SW US VETERANS HOSPITAL RD, PORTLAND, OR 97239-2964
(503) 220-8262
Mailing address
BLDG 834 SIXTH ST BOX 2518, LITTLE ROCK AFB, AR 72099-0001
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
PTA...13101
CO
Other
Enumeration date
06/16/2023
Last updated
06/16/2023
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