Provider Demographics
NPI:1003532987
Name:VILLAS, NITA
Entity Type:Individual
Prefix:
First Name:NITA
Middle Name:
Last Name:VILLAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 BROADWAY STE 812
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3024
Mailing Address - Country:US
Mailing Address - Phone:510-625-8039
Mailing Address - Fax:
Practice Address - Street 1:2201 BROADWAY STE 812
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-3024
Practice Address - Country:US
Practice Address - Phone:510-625-8039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-13
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8804237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist