Provider Demographics
NPI:1235714189
Name:VILLA-QUEVEDO, DANIEL (PMHNP)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:VILLA-QUEVEDO
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5766 W LUPINE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-3329
Mailing Address - Country:US
Mailing Address - Phone:602-565-8806
Mailing Address - Fax:
Practice Address - Street 1:5766 W LUPINE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-3329
Practice Address - Country:US
Practice Address - Phone:602-565-8806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-12
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN207780163W00000X
AZ261161363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse