Provider Demographics
NPI:1225855893
Name:VILLALTA, ERICK JAMIE JR
Entity type:Individual
Prefix:
First Name:ERICK
Middle Name:JAMIE
Last Name:VILLALTA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ERICK
Other - Middle Name:JAMIE
Other - Last Name:VILLALTA
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1100 1ST ST SE APT 1406
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-4731
Mailing Address - Country:US
Mailing Address - Phone:202-427-1548
Mailing Address - Fax:
Practice Address - Street 1:1100 1ST ST SE APT 1406
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-4731
Practice Address - Country:US
Practice Address - Phone:202-427-1548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-24
Last Update Date:2024-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant