Provider Demographics
NPI:1720073273
Name:VILLANUEVA, DAVID SCOTT (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:SCOTT
Last Name:VILLANUEVA
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:6501 E GREENWAY PARKWAY
Mailing Address - Street 2:SUITE 103-433
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-2065
Mailing Address - Country:US
Mailing Address - Phone:480-347-0844
Mailing Address - Fax:480-347-0885
Practice Address - Street 1:6501 E GREENWAY PARKWAY
Practice Address - Street 2:SUITE 103-433
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-2065
Practice Address - Country:US
Practice Address - Phone:480-347-0844
Practice Address - Fax:480-347-0885
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2015-05-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ2694363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ791493Medicaid
AZP00060749OtherRAILROAD MEDICARE
AZP71011Medicare UPIN
AZ75724Medicare PIN