Provider Demographics
NPI:1376601690
Name:VILLANUEVA, BENEDICT CORTEZ (MD)
Entity Type:Individual
Prefix:DR
First Name:BENEDICT
Middle Name:CORTEZ
Last Name:VILLANUEVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2557 MOWRY AVE STE 12
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1614
Mailing Address - Country:US
Mailing Address - Phone:510-248-1550
Mailing Address - Fax:510-793-8783
Practice Address - Street 1:2557 MOWRY AVE STE 12
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1614
Practice Address - Country:US
Practice Address - Phone:510-248-1550
Practice Address - Fax:510-793-8783
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61699207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG76577Medicare ID - Type Unspecified