Provider Demographics
NPI:1053862409
Name:VIRTUCIO, MARIA OFELIA VILLA (RN)
Entity Type:Individual
Prefix:
First Name:MARIA OFELIA
Middle Name:VILLA
Last Name:VIRTUCIO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:OFELIA
Other - Middle Name:
Other - Last Name:VIRTUCIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:310 WEST 43RD ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-2545
Mailing Address - Country:US
Mailing Address - Phone:917-327-0128
Mailing Address - Fax:
Practice Address - Street 1:310 WEST 43RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036
Practice Address - Country:US
Practice Address - Phone:917-327-0128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-20
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY637271-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse