Provider Demographics
NPI:1073679031
Name:VILLANUEVA, HEIDI A (OD)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:A
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 56 BOX 35640
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-9787
Mailing Address - Country:US
Mailing Address - Phone:787-868-2181
Mailing Address - Fax:
Practice Address - Street 1:HC 56 BOX 35640
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-9787
Practice Address - Country:US
Practice Address - Phone:787-868-2181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR597152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist