Provider Demographics
NPI:1568575694
Name:VILLALVA, VENUS L (MD)
Entity Type:Individual
Prefix:
First Name:VENUS
Middle Name:L
Last Name:VILLALVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VENUS
Other - Middle Name:
Other - Last Name:WILKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2525 E BROADWAY ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-8049
Mailing Address - Country:US
Mailing Address - Phone:406-447-2885
Mailing Address - Fax:
Practice Address - Street 1:2525 E BROADWAY ST
Practice Address - Street 2:SUITE 101
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-8049
Practice Address - Country:US
Practice Address - Phone:406-447-2885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT47920991205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics