Healthcare Provider Details

I. General information

NPI: 1376308171
Provider Name (Legal Business Name): MARIANA CHAVEZ VILLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2024
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

601 ELMWOOD AVE # SURG
ROCHESTER NY
14642-8410
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-1611
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number344045
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: