Provider Demographics
NPI:1700862885
Name:VILLEGAS, BERNARD J (MD)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:J
Last Name:VILLEGAS
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 1:10101 N 92ND ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4553
Mailing Address - Country:US
Mailing Address - Phone:480-747-6532
Mailing Address - Fax:480-889-6865
Practice Address - Street 1:10101 N 92ND ST STE 101
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4553
Practice Address - Country:US
Practice Address - Phone:480-747-6532
Practice Address - Fax:480-889-6865
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ23616163WC3500X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No163WC3500XNursing Service ProvidersRegistered NurseCardiac Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ335043Medicaid
AZ335043Medicaid