Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MT210429 | PA |
Y | 2080P0210X | Pediatric Nephrologist | MT210429 | PA |
NPI | 1861842643 |
---|---|
Provider Name | Leonela Amelia Villegas |
First Address | Philadelphia, PA 19104-4319 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2016 |
Last Update Date | 25/06/2019 |