Provider Demographics
NPI:1215205141
Name:VILLANUEVA, THELMA CALO (MD)
Entity Type:Individual
Prefix:DR
First Name:THELMA
Middle Name:CALO
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:THELMA
Other - Middle Name:C
Other - Last Name:VILLANUEVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:408 W CRANE ST
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:KS
Mailing Address - Zip Code:67654-1122
Mailing Address - Country:US
Mailing Address - Phone:914-472-7509
Mailing Address - Fax:914-472-7509
Practice Address - Street 1:408 W CRANE ST
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:KS
Practice Address - Zip Code:67654-1122
Practice Address - Country:US
Practice Address - Phone:914-472-7509
Practice Address - Fax:914-472-7509
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-31737207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology