Healthcare Provider Details

I. General information

NPI: 1972505881
Provider Name (Legal Business Name): VILLARAZA CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 04/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 N SPENCER SUITE 1
MESA AZ
85203-4347
US

IV. Provider business mailing address

P.O. BOX 790
MESA AZ
85211-0790
US

V. Phone/Fax

Practice location:
  • Phone: 480-726-6553
  • Fax: 480-726-3329
Mailing address:
  • Phone: 480-726-6553
  • Fax: 480-726-3329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHHA 3549
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierHHA 3549
Identifier TypeOTHER
Identifier StateAZ
Identifier IssuerSTATE LICENSE NUMBER

VIII. Authorized Official

Name: MRS. EVA LORANE TEJADA WARD
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 480-726-6553