Healthcare Provider Details

I. General information

NPI: 1023448735
Provider Name (Legal Business Name): IRENE VILLALPANDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2013
Last Update Date: 06/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2270 S RIDGEVIEW DR STE 303
YUMA AZ
85364-8866
US

IV. Provider business mailing address

PO BOX 5148
YUMA AZ
85366-2458
US

V. Phone/Fax

Practice location:
  • Phone: 928-782-1903
  • Fax: 928-782-1703
Mailing address:
  • Phone: 928-782-1903
  • Fax: 928-782-1703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberTAP5224
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP5224
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: