Healthcare Provider Details

I. General information

NPI: 1104990340
Provider Name (Legal Business Name): NELSON A. VILLAMOR, M.D. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 08/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 N 16TH ST SUITE 150
PHOENIX AZ
85020-4431
US

IV. Provider business mailing address

PO BOX 39179
PHOENIX AZ
85069-9179
US

V. Phone/Fax

Practice location:
  • Phone: 602-395-0718
  • Fax: 602-277-8146
Mailing address:
  • Phone: 602-395-0718
  • Fax: 602-277-8146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberAV0134230
License Number StateAZ

VIII. Authorized Official

Name: NELSON A VILLMOR
Title or Position: DOCTOR
Credential: M.D.
Phone: 602-395-0718