Provider Demographics
NPI:1801017348
Name:VILAR, AIDA C (RN)
Entity type:Individual
Prefix:MRS
First Name:AIDA
Middle Name:C
Last Name:VILAR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 S 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85007-3826
Mailing Address - Country:US
Mailing Address - Phone:602-452-6851
Mailing Address - Fax:602-257-2915
Practice Address - Street 1:1310 S 15TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85007-3826
Practice Address - Country:US
Practice Address - Phone:602-452-6851
Practice Address - Fax:602-257-2915
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN029088163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ588105Medicaid