Provider Demographics
NPI:1790274397
Name:VILLEGAS, EDWINA N
Entity Type:Individual
Prefix:MRS
First Name:EDWINA
Middle Name:N
Last Name:VILLEGAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-2615
Mailing Address - Country:US
Mailing Address - Phone:856-910-2442
Mailing Address - Fax:856-330-4923
Practice Address - Street 1:815 FULTON ST
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-2615
Practice Address - Country:US
Practice Address - Phone:856-910-2442
Practice Address - Fax:856-330-4923
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2069198343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)