Provider Demographics
NPI:1013750249
Name:VILLAMAYOR, LEO RALPH PUBLICO (MBA, MN, BSN, RN)
Entity type:Individual
Prefix:MR
First Name:LEO RALPH
Middle Name:PUBLICO
Last Name:VILLAMAYOR
Suffix:
Gender:M
Credentials:MBA, MN, BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 2ND ST SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55902-1906
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1216 2ND ST SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902-1906
Practice Address - Country:US
Practice Address - Phone:507-266-7890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-15
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX955920163W00000X
MN2521527163W00000X
NY873246163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse