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General NPI Number Information
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NPI Number | 1740248756
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Entity Type | Individual
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Provider Name | SYLVIA FERNANDEZ VILLARREAL MD
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Gender | Female
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Dates
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Enumeration Date | 05/02/2006
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Last Update Date | 03/11/2011
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Provider Practice Location Address
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Address Line | 1393 WEIMER RD
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City | TAOS
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State | NM
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Zip | 87571-6253
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Country | US
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Telephone | 505-758-8651
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Fax |
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Provider Business Mailing Address
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Address Line | 1393 WEIMER RD
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City | TAOS
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State | NM
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Zip | 87571-6253
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Country | US
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Telephone | 505-758-8651
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Fax |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 97-161
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License Number State | NM
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