Healthcare Provider Details

I. General information

NPI: 1861220303
Provider Name (Legal Business Name): LOURDES Y ROJAS VILLANUEVA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 07/25/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HWY 86 & TOPAWA RD
SELLS AZ
85634
US

IV. Provider business mailing address

2456 BLOWING BREEZE AVE
KISSIMMEE FL
34744-6156
US

V. Phone/Fax

Practice location:
  • Phone: 520-383-7330
  • Fax:
Mailing address:
  • Phone: 321-440-0098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN9478162
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: