MEDICARE: DR. NICOLAS ALFONSO VILLA GUILLEN M.D.

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	207RG0100X	Gastroenterology Physician	MD60501812	WA
2	207R00000X	Internal Medicine Physician	BP10031201	TX

General Provider Information

NPI Number	:	1265696553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLAS ALFONSO VILLA GUILLEN M.D.

Provider Business Mailing Address
First Line	:	1200 AIRPORT HEIGHTS DR
Second Line	:	STE 210
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-2969
Country	:	US
Telephone Number	:	509-939-4539
Fax Number	:

Provider Business Practice Location Address
First Line	:	910 W 5TH AVE STE 501
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99204-2967
Country	:	US
Telephone Number	:	509-838-2531
Fax Number	:	509-755-6580

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

Provider Enumeration Date	:	07/15/2008
Last Update Date	:	09/28/2021

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