Provider Demographics
NPI:1689859266
Name:VILLAREAL, RONALD DELA (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:DELA
Last Name:VILLAREAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1129 NORTHERN BLVD
Mailing Address - Street 2:STE. 101
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3045
Mailing Address - Country:US
Mailing Address - Phone:516-365-5570
Mailing Address - Fax:516-365-5532
Practice Address - Street 1:1129 NORTHERN BLVD
Practice Address - Street 2:101
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3045
Practice Address - Country:US
Practice Address - Phone:516-365-5570
Practice Address - Fax:516-365-5532
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN99052287A207RN0300X
IN01071586207R00000X
NY263968207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN2010864902Medicaid
INM400072957Medicare PIN
IN2010864902Medicaid