Healthcare Provider Details

I. General information

NPI: 1295061505
Provider Name (Legal Business Name): CHRISTOPHER P. VILLAMAYOR CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2009
Last Update Date: 01/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 CENTRAL AVE
PHILADELPHIA PA
19111-2442
US

IV. Provider business mailing address

105 MORNINGSIDE CIR
CHALFONT PA
18914-2419
US

V. Phone/Fax

Practice location:
  • Phone: 267-240-0927
  • Fax:
Mailing address:
  • Phone: 267-240-0927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN538821
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: