Healthcare Provider Details

I. General information

NPI: 1114991007
Provider Name (Legal Business Name): CHRISTINE B VILLARINO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 12/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N. INDIANA AVE
WINSLOW AZ
86047-2169
US

IV. Provider business mailing address

500 N. INDIANA AVE
WINSLOW AZ
86047-2169
US

V. Phone/Fax

Practice location:
  • Phone: 928-289-4646
  • Fax: 928-289-6290
Mailing address:
  • Phone: 928-289-4646
  • Fax: 928-289-6290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number22358
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: