Individual
MANUEL BUNOAN VILLANUEVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6070 ROBERT C BYRD DRIVE, BRADLEY, WV 25818
(304) 877-2600
(304) 877-2600
Mailing address
PO BOX 265, DRAWER 329, BRADLEY, WV 25818
(304) 877-2600
(304) 877-2600
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11992
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0056004000
—
WV
01
—
MA9195181
MEDICARE GROUP PIN
WV
Enumeration date
10/04/2006
Last updated
02/19/2008
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