Provider Demographics
NPI:1588617583
Name:VILLELLA, RAFFAELA M A (DC)
Entity Type:Individual
Prefix:DR
First Name:RAFFAELA
Middle Name:M A
Last Name:VILLELLA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4606 CLAREMONT PARK DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34211-9403
Mailing Address - Country:US
Mailing Address - Phone:716-510-7007
Mailing Address - Fax:
Practice Address - Street 1:4606 CLAREMONT PARK DR
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34211-9403
Practice Address - Country:US
Practice Address - Phone:716-510-7007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9126111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor