Provider Demographics
NPI:1043304652
Name:VILLANUEVA, MARIANELA (MT)
Entity type:Individual
Prefix:MRS
First Name:MARIANELA
Middle Name:
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. VALLES DE AASCO #119
Mailing Address - Street 2:
Mailing Address - City:AASCO
Mailing Address - State:PUERTORICO
Mailing Address - Zip Code:00610
Mailing Address - Country:UM
Mailing Address - Phone:787-832-2345
Mailing Address - Fax:787-832-2345
Practice Address - Street 1:CALLE MENDEZ VIGO #110 E
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-832-2345
Practice Address - Fax:787-832-2345
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR995291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory