Healthcare Provider Details

I. General information

NPI: 1255100426
Provider Name (Legal Business Name): RHALP VILLANUEVA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2023
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2108 BORBECK AVE
PHILADELPHIA PA
19152-3725
US

IV. Provider business mailing address

2108 BORBECK AVE
PHILADELPHIA PA
19152-3725
US

V. Phone/Fax

Practice location:
  • Phone: 215-245-2131
  • Fax:
Mailing address:
  • Phone: 215-245-2131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN756895
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: