Provider Demographics
NPI:1750904264
Name:VILLANUEVA, FRANK (COTA)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:VILLANUEVA
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8858 CLAVEL DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79907-4928
Mailing Address - Country:US
Mailing Address - Phone:956-257-9379
Mailing Address - Fax:
Practice Address - Street 1:711 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:DENVER CITY
Practice Address - State:TX
Practice Address - Zip Code:79323-3000
Practice Address - Country:US
Practice Address - Phone:956-257-9379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-19
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216206314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility