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NPI Code Detail

MEDICARE: MS. AILEA VILLANUEVA MS CCC-SLP

MEDICARE: MS. AILEA VILLANUEVA MS CCC-SLP
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
1235Z00000XSpeech-Language PathologistSP-1273NV

General Provider Information

NPI Number : 1356634299
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. AILEA VILLANUEVA MS CCC-SLP
Provider Business Mailing Address
First Line : 3144 DARBY FALLS DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89134-7420
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2250 E FLAMINGO RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-5170
Country : US
Telephone Number : 702-784-4303
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2011
Last Update Date : 05/25/2011

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