Provider Demographics
NPI:1962678201
Name:VILLEGAS, TIMOTHY BENGZON (MA)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:BENGZON
Last Name:VILLEGAS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47-344 WAIHEE RD
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-4949
Mailing Address - Country:US
Mailing Address - Phone:808-239-1531
Mailing Address - Fax:
Practice Address - Street 1:47-344 WAIHEE RD
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-4949
Practice Address - Country:US
Practice Address - Phone:808-239-1531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health