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General NPI Number Information
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NPI Number | 1598837130
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Entity Type | Organization
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Legal Business Name | CHONA M. EBALO-VILLANUEVA DMD INC
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 08/25/2008
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Provider Practice Location Address
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Address Line | 12 N ABEL ST
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City | MILPITAS
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State | CA
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Zip | 95035-4833
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Country | US
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Telephone | 408-946-9696
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Fax | 408-946-5381
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Provider Business Mailing Address
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Address Line | 12 N ABEL ST
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City | MILPITAS
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State | CA
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Zip | 95035-4833
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Country | US
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Telephone | 408-946-9696
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Fax | 408-946-5381
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. FIDEL A VILLANUEVA
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Credential | R.N.
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Telephone | 408-946-9696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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