Provider Demographics
NPI:1376560896
Name:VILLAFLOR & VILLAFLOR A PROF CORP
Entity Type:Organization
Organization Name:VILLAFLOR & VILLAFLOR A PROF CORP
Other - Org Name:FAMILY HEALTH CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FLORENCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:VILLAFLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-796-4007
Mailing Address - Street 1:3650 S EASTERN AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-3379
Mailing Address - Country:US
Mailing Address - Phone:702-796-4007
Mailing Address - Fax:702-796-3993
Practice Address - Street 1:3650 S EASTERN AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-3379
Practice Address - Country:US
Practice Address - Phone:702-796-4007
Practice Address - Fax:702-796-3993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6918207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2019595Medicaid
NV2019595Medicaid
NVWJBDV01Medicare ID - Type Unspecified