Healthcare Provider Details

I. General information

NPI: 1538733746
Provider Name (Legal Business Name): PAULINA GUADALUPE VILLANUEVA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2021
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CEDAR ST SE STE 800
ALBUQUERQUE NM
87106-4912
US

IV. Provider business mailing address

PO BOX 26666 PHS PROVIDER ENROLLMENT
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-563-2500
  • Fax: 505-563-2531
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD2026-0377
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: