Healthcare Provider Details

I. General information

NPI: 1740012863
Provider Name (Legal Business Name): HENRY VILLEGAS LANDINGIN IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2024
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HADNOT POINT 165 I STREET
CAMP LEJEUNE NC
28547
US

IV. Provider business mailing address

HADNOT POINT 165 I STREET
CAMP LEJEUNE NC
28547
US

V. Phone/Fax

Practice location:
  • Phone: 910-450-3086
  • Fax:
Mailing address:
  • Phone: 619-748-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: