Provider Demographics
NPI:1114937984
Name:DEL CARMEN, VILLA AULEEN (MD)
Entity Type:Individual
Prefix:
First Name:VILLA
Middle Name:AULEEN
Last Name:DEL CARMEN
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:PO BOX 6210
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87499-6210
Mailing Address - Country:US
Mailing Address - Phone:505-609-2258
Mailing Address - Fax:505-609-2259
Practice Address - Street 1:801 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-5630
Practice Address - Country:US
Practice Address - Phone:505-609-6463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116015347207R00000X
NMMD2006-0490207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM22103007Medicaid
NM22103007OtherHOBBS AHCCCS
NMP00382871OtherRAILROAD MEDICARE
NM15064401OtherFARMINGTON AHCCCS
NMP00382871OtherRAIL ROAD MEDICARE
NM15064401OtherFARMINGTON AHCCCS
NMP00382871OtherRAILROAD MEDICARE