Provider Demographics
NPI:1518607258
Name:MINDY ESTELLA VILLA
Entity Type:Organization
Organization Name:MINDY ESTELLA VILLA
Other - Org Name:SUNLAND CLINIC LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLA
Authorized Official - Suffix:
Authorized Official - Credentials:ANP-BC
Authorized Official - Phone:915-202-4463
Mailing Address - Street 1:1155 MCNUTT RD STE 104
Mailing Address - Street 2:
Mailing Address - City:SUNLAND PARK
Mailing Address - State:NM
Mailing Address - Zip Code:88063-9176
Mailing Address - Country:US
Mailing Address - Phone:915-202-4463
Mailing Address - Fax:
Practice Address - Street 1:1155 MCNUTT RD STE 104
Practice Address - Street 2:
Practice Address - City:SUNLAND PARK
Practice Address - State:NM
Practice Address - Zip Code:88063-9176
Practice Address - Country:US
Practice Address - Phone:915-202-4463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-30
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care