Provider Demographics
NPI:1427319466
Name:VILLANUEVA, ANA MARIA (DOM, AP)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:MARIA
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:DOM, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 RIVERSTONE COMMONS CIR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-5237
Mailing Address - Country:US
Mailing Address - Phone:813-758-5222
Mailing Address - Fax:
Practice Address - Street 1:122 RIVERSTONE COMMONS CIR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-5237
Practice Address - Country:US
Practice Address - Phone:813-758-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA312171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist