Provider Demographics
NPI:1649591421
Name:DELA LUNA, JONATHAN VILLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:VILLAS
Last Name:DELA LUNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 MENDON RD STE 21
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-3825
Mailing Address - Country:US
Mailing Address - Phone:401-333-3810
Mailing Address - Fax:
Practice Address - Street 1:2180 MENDON RD STE 21
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-3825
Practice Address - Country:US
Practice Address - Phone:401-333-3810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD145292084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program