Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 23036 | AZ |
NPI | 1003802604 |
---|---|
Provider Name | Aileen F Villareal |
First Address | Phoenix, AZ 85018-3978 |
Second Address | Phoenix, AZ 85018-3978 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
496639-02 | (05) | AZ |
AZ0378590 | BCBS (01) | |
G03516 | (02) |