Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 35084433 | OH |
Y | 207Q00000X | Family Doctor | 35878 | KY |
N | 207QA0401X | Family Doctor - Addiction Medicine | 35.084433 | OH |
N | 207QA0401X | Family Doctor - Addiction Medicine | 35878 | KY |
NPI | 1720027675 |
---|---|
Provider Name | Dr. Cynthia Huyck Villacis |
First Address | Edgewood, KY 41017-3306 |
Second Address | Florence, KY 41042-5172 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 04/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2319226 | (05) | OH |
64049679 | (05) | KY |
H63935 | (02) |