Provider Demographics
NPI:1235689142
Name:VILLANUEVA, MAIRA VERONICA
Entity Type:Individual
Prefix:
First Name:MAIRA
Middle Name:VERONICA
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7077 VISTA BLVD UNIT 5103
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-8026
Mailing Address - Country:US
Mailing Address - Phone:775-857-8813
Mailing Address - Fax:
Practice Address - Street 1:3500 LAKESIDE CT STE 101
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4862
Practice Address - Country:US
Practice Address - Phone:775-786-6880
Practice Address - Fax:775-786-6899
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator