Provider Demographics
NPI:1003802604
Name:VILLAREAL, AILEEN F (MD)
Entity Type:Individual
Prefix:
First Name:AILEEN
Middle Name:F
Last Name:VILLAREAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 N 32ND ST
Mailing Address - Street 2:STE 280
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3978
Mailing Address - Country:US
Mailing Address - Phone:602-266-6888
Mailing Address - Fax:602-266-6895
Practice Address - Street 1:4400 N 32ND ST
Practice Address - Street 2:STE 280
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-3978
Practice Address - Country:US
Practice Address - Phone:602-266-6888
Practice Address - Fax:602-266-6895
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23036207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ496639-02Medicaid
AZ0378590OtherBCBS
AZ496639-02Medicaid
AZ18WCHTC03Medicare ID - Type Unspecified