Provider Demographics
NPI:1720370372
Name:VILLADIEGO, MARIZA DELUNA
Entity Type:Individual
Prefix:
First Name:MARIZA
Middle Name:DELUNA
Last Name:VILLADIEGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIZA
Other - Middle Name:ALVAREZ
Other - Last Name:DELUNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2760 LAKE SAHARA DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-3438
Mailing Address - Country:US
Mailing Address - Phone:702-222-0792
Mailing Address - Fax:
Practice Address - Street 1:2760 LAKE SAHARA DR
Practice Address - Street 2:SUITE 108
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-3438
Practice Address - Country:US
Practice Address - Phone:702-222-0792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner