MEDICARE: ANGEL L VILLANUEVA JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	35.041340	OH
2	2084P0800X	Psychiatry Physician	35.041340	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255370714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGEL L VILLANUEVA JR. MD

Provider Business Mailing Address
First Line	:	4770 INDIANOLA AVE STE 107
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-1862
Country	:	US
Telephone Number	:	614-371-2303
Fax Number	:	800-905-9950

Provider Business Practice Location Address
First Line	:	4770 INDIANOLA AVE STE 107
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-1862
Country	:	US
Telephone Number	:	614-371-2303
Fax Number	:	800-905-9950

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	11/19/2025

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