Provider Demographics
NPI:1760875272
Name:ERAZO VILLEGAS, GEOVANNA PAOLA (PA)
Entity Type:Individual
Prefix:
First Name:GEOVANNA
Middle Name:PAOLA
Last Name:ERAZO VILLEGAS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14128 84TH DR
Mailing Address - Street 2:APT 6G
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435-2413
Mailing Address - Country:US
Mailing Address - Phone:516-287-0493
Mailing Address - Fax:
Practice Address - Street 1:14128 84TH DR
Practice Address - Street 2:APT 6G
Practice Address - City:BRIARWOOD
Practice Address - State:NY
Practice Address - Zip Code:11435-2413
Practice Address - Country:US
Practice Address - Phone:516-287-0493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-08
Last Update Date:2016-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant