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Individual

IDA Z VILLANUEVA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
252 RURAL ACRES DR, BECKLEY, WV 25801-3503
(304) 252-8551
(304) 252-1790
Mailing address
252 RURAL ACRES DR, BECKLEY, WV 25801-3503
(304) 252-8551
(304) 252-1790

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
12015
WV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0048917000
WV
05
14867
WV
01
205832
CARELINK
01
288986
UNITEDHEALTHCARE
05
A12015
WV
01
D49309
HEALTH NET
Enumeration date
10/03/2006
Last updated
07/17/2007
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