Provider Demographics
NPI:1386124519
Name:VILLANUEVA, ELIZABETH ALLEN
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ALLEN
Last Name:VILLANUEVA
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 1:4811 FAIRFORD DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-1013
Mailing Address - Country:US
Mailing Address - Phone:210-689-9312
Mailing Address - Fax:
Practice Address - Street 1:4811 FAIRFORD DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-1013
Practice Address - Country:US
Practice Address - Phone:210-689-9312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)