MEDICARE: DR. MIRIAM GISELA VILLANUEVA SCHWAN 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	208000000X	Pediatrics Physician	34314	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	964438	OTHER	AZ	AHHCCCS

General Provider Information

NPI Number	:	1255446738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIRIAM GISELA VILLANUEVA SCHWAN MD

Provider Business Mailing Address
First Line	:	18699 N 67TH AVE
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-7140
Country	:	US
Telephone Number	:	623-594-7337
Fax Number	:	623-594-7340

Provider Business Practice Location Address
First Line	:	18699 N 67TH AVE
Second Line	:	SUITE 240
City	:	GLENDALE
State	:	AZ
Zip	:	85308-7140
Country	:	US
Telephone Number	:	623-594-7337
Fax Number	:	623-564-7340

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	11/06/2012

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