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Individual

BETHEL VILLAVICENCIO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
4500 S LANCASTER RD, DALLAS, TX 75216-7167
(214) 857-1625
Mailing address
3508 GAGEWAY CT, MESQUITE, TX 75150-4362
(972) 279-1352

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704097296
TX

Other

Enumeration date
05/18/2007
Last updated
07/08/2007
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