Healthcare Provider Details

I. General information

NPI: 1134660962
Provider Name (Legal Business Name): MRS. KARINA VILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2017
Last Update Date: 03/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

578 7TH AVE
AURORA IL
60505-5364
US

IV. Provider business mailing address

578 7TH AVE
AURORA IL
60505-5364
US

V. Phone/Fax

Practice location:
  • Phone: 630-414-5328
  • Fax:
Mailing address:
  • Phone: 630-414-5328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License NumberV40050095814
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: