Provider Demographics
NPI:1114005931
Name:VILLANUEVA, ROSITA VILLEGAS (MD)
Entity Type:Individual
Prefix:MRS
First Name:ROSITA
Middle Name:VILLEGAS
Last Name:VILLANUEVA
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 1:4200 WARRENSVILLE CENTER RD
Mailing Address - Street 2:SUITE# 380
Mailing Address - City:WARRENSVILLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-7051
Mailing Address - Country:US
Mailing Address - Phone:216-283-5144
Mailing Address - Fax:216-283-5750
Practice Address - Street 1:4200 WARRENSVILLE CENTER RD
Practice Address - Street 2:SUITE# 380
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-7051
Practice Address - Country:US
Practice Address - Phone:216-283-5144
Practice Address - Fax:216-283-5750
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35032999282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0187499Medicaid
OHV10420202Medicare ID - Type Unspecified
OHC01291Medicare UPIN