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NPI Code Detail

MEDICARE: RAQUEL YSABEL VILLASENOR LMT, NCBTMB

MEDICARE: RAQUEL YSABEL VILLASENOR LMT, NCBTMB
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
1174400000XSpecialistMT-17744AZ

General Provider Information

NPI Number : 1386082055
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAQUEL YSABEL VILLASENOR LMT, NCBTMB
Provider Business Mailing Address
First Line : 5630 S HIGHWAY 95
Second Line : #3B
City : FORT MOHAVE
State : AZ
Zip : 86426-6041
Country : US
Telephone Number : 480-296-1509
Fax Number :
Provider Business Practice Location Address
First Line : 5630 S HIGHWAY 95
Second Line : #3B
City : FORT MOHAVE
State : AZ
Zip : 86426-6041
Country : US
Telephone Number : 480-296-1509
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2013
Last Update Date : 06/04/2013

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