Provider Demographics
NPI:1730426685
Name:VILLANUEVA, MAGDALENA YERRO
Entity type:Individual
Prefix:MRS
First Name:MAGDALENA
Middle Name:YERRO
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 1:3738 TUNDRA SWAN ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89122-3535
Mailing Address - Country:US
Mailing Address - Phone:702-673-0788
Mailing Address - Fax:
Practice Address - Street 1:3738 TUNDRA SWAN ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89122-3535
Practice Address - Country:US
Practice Address - Phone:702-673-0788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-12
Last Update Date:2013-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator