Provider Demographics
NPI:1962226662
Name:VILLA, ALEXIS KALEIHIILANI
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:KALEIHIILANI
Last Name:VILLA
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 1:146 NIAGARA DR
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-7433
Mailing Address - Country:US
Mailing Address - Phone:808-953-7820
Mailing Address - Fax:
Practice Address - Street 1:3507 JAIME ZAPATA MEMORIAL HWY STE 5
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78043-4770
Practice Address - Country:US
Practice Address - Phone:956-726-9252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1179703363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily