Healthcare Provider Details

I. General information

NPI: 1205853645
Provider Name (Legal Business Name): FELIPE C VILLASIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 BATTLEFIELD BLVD N
CHESAPEAKE VA
23320-4941
US

IV. Provider business mailing address

PO BOX 1361
VIRGINIA BEACH VA
23451-0361
US

V. Phone/Fax

Practice location:
  • Phone: 757-312-8121
  • Fax:
Mailing address:
  • Phone: 757-431-3976
  • Fax: 757-410-8963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101024474
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: