Provider Demographics
NPI:1457137713
Name:MONROY VILLA, JUAN CARLOS
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:CARLOS
Last Name:MONROY VILLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2922 W CHALFONT DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85742-0033
Mailing Address - Country:US
Mailing Address - Phone:520-780-6190
Mailing Address - Fax:
Practice Address - Street 1:2922 W CHALFONT DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85742-0033
Practice Address - Country:US
Practice Address - Phone:520-780-6190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN271142163WX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WX0800XNursing Service ProvidersRegistered NurseOrthopedicGroup - Single Specialty