Provider Demographics
NPI:1043540008
Name:DUARTE, HERIBERTO VILLANUEVA
Entity Type:Individual
Prefix:MR
First Name:HERIBERTO
Middle Name:VILLANUEVA
Last Name:DUARTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 W CAMINO RIO CEBOLLA
Mailing Address - Street 2:
Mailing Address - City:SAHUARITA
Mailing Address - State:AZ
Mailing Address - Zip Code:85629-8838
Mailing Address - Country:US
Mailing Address - Phone:520-207-5125
Mailing Address - Fax:
Practice Address - Street 1:1880 E IRVINGTON RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85714-1754
Practice Address - Country:US
Practice Address - Phone:520-294-1975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS012954183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist