Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 2020017808 | MO |
NPI | 1063183507 |
---|---|
Provider Name | Joselyne Villa-Flores |
First Address | Trenton, MO 64683-1325 |
Second Address | Trenton, MO 64683-1325 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2021 |
Last Update Date | 24/09/2021 |