Provider Demographics
NPI:1124327226
Name:MUANA, OWEN VILLAGONZALO (MD)
Entity type:Individual
Prefix:DR
First Name:OWEN
Middle Name:VILLAGONZALO
Last Name:MUANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:OWEN NINO
Other - Middle Name:VILLAGONZALO
Other - Last Name:MUANA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3960 TURNPIKE ROAD
Mailing Address - Street 2:JENCARE NEIGHBORHOOD MEDICAL CENTER VICTORY, LLC
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23710
Mailing Address - Country:US
Mailing Address - Phone:757-393-1136
Mailing Address - Fax:757-393-5534
Practice Address - Street 1:3960 TURNPIKE ROAD
Practice Address - Street 2:JENCARE NEIGHBORHOOD MEDICAL CENTER VICTORY, LLC
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23710
Practice Address - Country:US
Practice Address - Phone:757-393-1136
Practice Address - Fax:757-393-5534
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-15
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY259838207R00000X
HI16046207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine