Provider Demographics
NPI:1023448735
Name:VILLALPANDO, IRENE
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:VILLALPANDO
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:PO BOX 5148
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85366-2458
Mailing Address - Country:US
Mailing Address - Phone:928-782-1903
Mailing Address - Fax:928-782-1703
Practice Address - Street 1:2270 S RIDGEVIEW DR STE 303
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8866
Practice Address - Country:US
Practice Address - Phone:928-782-1903
Practice Address - Fax:928-782-1703
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-15
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTAP5224363LF0000X
AZAP5224363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ877704Medicaid
AZ877704Medicaid