Provider Demographics
NPI:1851940647
Name:VILLANUEVA ROSA, ERICK (DC)
Entity Type:Individual
Prefix:DR
First Name:ERICK
Middle Name:
Last Name:VILLANUEVA ROSA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3106 AVE JUAN HERNANDEZ ORTIZ
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-3614
Mailing Address - Country:US
Mailing Address - Phone:787-354-1062
Mailing Address - Fax:
Practice Address - Street 1:3106 AVE JUAN HERNANDEZ ORTIZ
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-3614
Practice Address - Country:US
Practice Address - Phone:787-354-1062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000686111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor