Provider Demographics
NPI:1598059586
Name:VILLAPIANO, NICOLE LYNN GERGEN (MD)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:LYNN GERGEN
Last Name:VILLAPIANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:LYNN
Other - Last Name:GERGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5820 OWENS DR BLDG E2ND
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-3900
Mailing Address - Country:US
Mailing Address - Phone:925-737-3785
Mailing Address - Fax:
Practice Address - Street 1:5820 OWENS DR BLDG E 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-3900
Practice Address - Country:US
Practice Address - Phone:925-737-3785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP02344207R00000X, 208000000X
MI4301107537207R00000X, 208000000X
CAC196387207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04807916Medicaid