Provider Demographics
NPI:1710148796
Name:VILLONGCO, CRISTICITA MIRANDA (RN, MSN)
Entity Type:Individual
Prefix:MRS
First Name:CRISTICITA
Middle Name:MIRANDA
Last Name:VILLONGCO
Suffix:
Gender:F
Credentials:RN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1966 LOUIS KOSSUTH AVE
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-6423
Mailing Address - Country:US
Mailing Address - Phone:631-648-8058
Mailing Address - Fax:
Practice Address - Street 1:1966 LOUIS KOSSUTH AVE
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-6423
Practice Address - Country:US
Practice Address - Phone:631-648-8058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-22
Last Update Date:2008-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY545497-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse