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General NPI Number Information
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NPI Number | 1427269802
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Entity Type | Individual
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Provider Name | CAROL KITAY VILLANUEVA DO
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Gender | Female
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 03/16/2010
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Provider Practice Location Address
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Address Line | 6701 HERITAGE PKWY STE 160
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City | ROCKWALL
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State | TX
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Zip | 75087-8747
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Country | US
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Telephone | 972-412-2113
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Fax | 972-412-3991
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Provider Business Mailing Address
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Address Line | 6701 HERITAGE PKWY STE 160
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City | ROCKWALL
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State | TX
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Zip | 75087-8747
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Country | US
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Telephone | 972-412-2113
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Fax | 972-412-3991
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | M9721
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | PENDING
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License Number State | TX
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