Provider Demographics
NPI:1063619732
Name:VILLASENOR, JOSE SERVANDO (CSA)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:SERVANDO
Last Name:VILLASENOR
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6795 E TENNESSEE AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-1653
Mailing Address - Country:US
Mailing Address - Phone:303-234-9888
Mailing Address - Fax:303-926-0910
Practice Address - Street 1:6795 E TENNESSEE AVE STE 280
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-1653
Practice Address - Country:US
Practice Address - Phone:303-234-9888
Practice Address - Fax:303-926-0910
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO06-105174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist