Healthcare Provider Details

I. General information

NPI: 1730559055
Provider Name (Legal Business Name): DIANA VILLANEUVA BSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANA PATRICIA NIETO

II. Dates (important events)

Enumeration Date: 09/29/2015
Last Update Date: 09/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 SAN PABLO
ALBUQUERQUE NM
87108
US

IV. Provider business mailing address

1101 LOPEZ ROAD SW
ALBUQUERQUE NM
87105
US

V. Phone/Fax

Practice location:
  • Phone: 505-944-7224
  • Fax: 505-944-7229
Mailing address:
  • Phone: 505-877-7060
  • Fax: 505-877-7063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: