Provider Demographics
NPI:1538108303
Name:VILLA, EDEN (MD)
Entity Type:Individual
Prefix:
First Name:EDEN
Middle Name:
Last Name:VILLA
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 1:1814 DEVONSHIRE CRES
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4148
Mailing Address - Country:US
Mailing Address - Phone:713-795-8047
Mailing Address - Fax:
Practice Address - Street 1:4545 POST OAK PLACE DR
Practice Address - Street 2:SUITE 130
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-3164
Practice Address - Country:US
Practice Address - Phone:713-960-8008
Practice Address - Fax:713-960-0965
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5941207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G80012Medicare UPIN
TX8B2921Medicare PIN