Provider Demographics
NPI:1194447938
Name:VILLAVICENCIO, SHARON MARIE (CSFA)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:MARIE
Last Name:VILLAVICENCIO
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 MILLSTONE CANYON LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-1570
Mailing Address - Country:US
Mailing Address - Phone:832-469-3930
Mailing Address - Fax:
Practice Address - Street 1:2202 MILLSTONE CANYON LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-1570
Practice Address - Country:US
Practice Address - Phone:832-469-3930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213126246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant