Provider Demographics
NPI:1801073481
Name:VILLALUZ, ZEPHYRENE C (MD)
Entity type:Individual
Prefix:DR
First Name:ZEPHYRENE
Middle Name:C
Last Name:VILLALUZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 CIVIC CENTER DR
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-7113
Mailing Address - Country:US
Mailing Address - Phone:702-642-8313
Mailing Address - Fax:
Practice Address - Street 1:1825 CIVIC CENTER DR
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-7113
Practice Address - Country:US
Practice Address - Phone:702-642-8313
Practice Address - Fax:702-242-3805
Is Sole Proprietor?:No
Enumeration Date:2008-01-26
Last Update Date:2008-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6679207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2019236Medicaid