Provider Demographics
NPI:1912589011
Name:VILLAMAYOR, MA. CARMONA
Entity Type:Individual
Prefix:
First Name:MA. CARMONA
Middle Name:
Last Name:VILLAMAYOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11225 N DYSART RD
Mailing Address - Street 2:
Mailing Address - City:EL MIRAGE
Mailing Address - State:AZ
Mailing Address - Zip Code:85335-4100
Mailing Address - Country:US
Mailing Address - Phone:623-889-4029
Mailing Address - Fax:
Practice Address - Street 1:15835 N 6TH PL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-3060
Practice Address - Country:US
Practice Address - Phone:623-889-4029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL10644H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility