Provider Demographics
NPI:1801850623
Name:VILLA, DEBORA (MD)
Entity Type:Individual
Prefix:MRS
First Name:DEBORA
Middle Name:
Last Name:VILLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11000 N SCOTTSDALE RD
Mailing Address - Street 2:STE 120
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-6130
Mailing Address - Country:US
Mailing Address - Phone:480-455-3000
Mailing Address - Fax:866-819-6115
Practice Address - Street 1:4045 E BELL RD
Practice Address - Street 2:SUITE 105
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2236
Practice Address - Country:US
Practice Address - Phone:602-923-6666
Practice Address - Fax:602-923-7676
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ15289207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0730250OtherBLUE CROSS BLUE SHIELD
AZ1Z3957OtherHEALTHNET
AZ1Z3957OtherHEALTHNET
AZMD65033Medicare ID - Type Unspecified