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General NPI Number Information
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NPI Number | 1790125391
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Entity Type | Individual
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Provider Name | JENNIFER VILLAVICENCIO MD
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Gender | Female
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Dates
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Enumeration Date | 06/27/2013
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Last Update Date | 11/21/2025
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Provider Practice Location Address
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Address Line | 1225 4TH ST NE
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City | WASHINGTON
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State | DC
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Zip | 20002-3431
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Country | US
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Telephone | 202-603-4794
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Fax |
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Provider Business Mailing Address
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Address Line | 2490 MARKET ST NE # 246
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City | WASHINGTON
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State | DC
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Zip | 20018-3851
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Country | US
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Telephone |
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 01098372A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | D90207
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MD048779
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License Number State | DC
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