Healthcare Provider Details

I. General information

NPI: 1801356332
Provider Name (Legal Business Name): DIANA MARIA VILLANUEVA DONMEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DIANA M VILLANUEVA DIANA VILLANUEVA, MD

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 05/13/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 TOLL GATE RD ASP BLDG SUITE PEACH
WARWICK RI
02886-2759
US

IV. Provider business mailing address

455 TOLL GATE ROAD PRC AND CREDENTIALING
PROVIDENCE RI
02904-2602
US

V. Phone/Fax

Practice location:
  • Phone: 401-681-2858
  • Fax: 401-921-6943
Mailing address:
  • Phone: 401-273-0641
  • Fax: 401-273-2919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD20098
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMD20098
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: