Healthcare Provider Details

I. General information

NPI: 1881625408
Provider Name (Legal Business Name): JUAN F VILLALONA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 08/23/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7229 FOREST AVE STE 106 THE HIGHLAND II MEDICAL OFFICE BUILDING
RICHMOND VA
23226-3765
US

IV. Provider business mailing address

7605 FOREST AVE., SUITE 316 PROFESSIONAL OFFICE BUILDING
HENRICO VA
23229-4939
US

V. Phone/Fax

Practice location:
  • Phone: 804-888-7337
  • Fax: 804-888-9738
Mailing address:
  • Phone: 804-307-6350
  • Fax: 804-888-9738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number0101239864
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: