Provider Demographics
NPI:1497877542
Name:VILLAREAL, ROSARIO ANDAYA (MD)
Entity Type:Individual
Prefix:
First Name:ROSARIO
Middle Name:ANDAYA
Last Name:VILLAREAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21580 GREENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-3006
Mailing Address - Country:US
Mailing Address - Phone:248-968-9371
Mailing Address - Fax:248-968-9392
Practice Address - Street 1:21580 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-3006
Practice Address - Country:US
Practice Address - Phone:248-968-9371
Practice Address - Fax:248-968-9392
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
4301041533171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF07104Medicare UPIN