Provider Demographics
NPI:1053643270
Name:VILLANUEVA, GUILLERMINA (SA-C)
Entity Type:Individual
Prefix:
First Name:GUILLERMINA
Middle Name:
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 WESTMINSTER PL
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-7636
Mailing Address - Country:US
Mailing Address - Phone:512-653-7249
Mailing Address - Fax:512-733-0199
Practice Address - Street 1:9715 BURNET RD
Practice Address - Street 2:#100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5215
Practice Address - Country:US
Practice Address - Phone:512-646-0072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-12
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00356246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant