Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 254706 | NY |
NPI | 1013027135 |
---|---|
Provider Name | Raissa Villanueva |
First Address | Rochester, NY 14627-8984 |
Second Address | Rochester, NY 14618-2628 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 01/03/2012 |