Provider Demographics
NPI:1194561829
Name:VILLANUEVA, PAOLA MARIE (MS)
Entity type:Individual
Prefix:MRS
First Name:PAOLA
Middle Name:MARIE
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1106
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676
Mailing Address - Country:US
Mailing Address - Phone:939-200-3629
Mailing Address - Fax:
Practice Address - Street 1:MOCA MEDICAL PLAZA NUM 113 CARR 110 KM 12 H 4
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676-9998
Practice Address - Country:US
Practice Address - Phone:939-200-3629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8073103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling