Provider Demographics
NPI:1275236713
Name:VILLEGAS, KATRINA JAVELOSA
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:JAVELOSA
Last Name:VILLEGAS
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 1:703 MAIN STREET
Mailing Address - Street 2:ST. JOSEPH'S HEALTH - DEPARTMENT OF INTERNAL MEDICINE
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07503-2621
Mailing Address - Country:US
Mailing Address - Phone:973-754-2431
Mailing Address - Fax:973-754-3376
Practice Address - Street 1:703 MAIN STREET
Practice Address - Street 2:ST. JOSEPH'S HEALTH - DEPARTMENT OF INTERNAL MEDICINE
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503-2621
Practice Address - Country:US
Practice Address - Phone:973-754-2431
Practice Address - Fax:973-754-3376
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program