MEDICARE: ZEPHYRENE C VILLALUZ MD CHTD

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	207Q00000X	Family Medicine Physician	6679	NV

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	:	1356415616
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZEPHYRENE C VILLALUZ MD CHTD

Provider Business Mailing Address
First Line	:	1825 CIVIC CENTER DRIVE
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89030
Country	:	US
Telephone Number	:	702-642-8313
Fax Number	:	702-642-8903

Provider Business Practice Location Address
First Line	:	1825 CIVIC CENTER DRIVE
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89030
Country	:	US
Telephone Number	:	702-642-8313
Fax Number	:	702-642-8903

Authorized Official
Title or Position	:	PRESIDENT OWNER
Name	:	DR. ZEPHYRENE C VILLALUZ
Credential	:	MD
Telephone Number	:	702-642-8313

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	08/22/2020

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