Provider Demographics
NPI:1427269802
Name:VILLANUEVA, CAROL KITAY (DO)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:KITAY
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:6701 HERITAGE PKWY
Mailing Address - Street 2:STE 160
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-8747
Mailing Address - Country:US
Mailing Address - Phone:972-412-2113
Mailing Address - Fax:972-412-3991
Practice Address - Street 1:6701 HERITAGE PKWY
Practice Address - Street 2:STE 160
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-8747
Practice Address - Country:US
Practice Address - Phone:972-412-2113
Practice Address - Fax:972-412-3991
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM9721207R00000X
TXPENDING207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine