Provider Demographics
NPI:1164311643
Name:VILLESCAS, LUZ MARIA
Entity type:Individual
Prefix:
First Name:LUZ
Middle Name:MARIA
Last Name:VILLESCAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 CALLE OBREGON
Mailing Address - Street 2:
Mailing Address - City:SUNLAND PARK
Mailing Address - State:NM
Mailing Address - Zip Code:88063-9354
Mailing Address - Country:US
Mailing Address - Phone:915-999-7988
Mailing Address - Fax:
Practice Address - Street 1:207 CALLE OBREGON
Practice Address - Street 2:
Practice Address - City:SUNLAND PARK
Practice Address - State:NM
Practice Address - Zip Code:88063-9354
Practice Address - Country:US
Practice Address - Phone:915-999-7988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMG-1600172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker