Provider Demographics
NPI:1255446738
Name:VILLANUEVA SCHWAN, MIRIAM GISELA (MD)
Entity type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:GISELA
Last Name:VILLANUEVA SCHWAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:18699 N 67TH AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-7140
Mailing Address - Country:US
Mailing Address - Phone:623-594-7337
Mailing Address - Fax:623-594-7340
Practice Address - Street 1:18699 N 67TH AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-7140
Practice Address - Country:US
Practice Address - Phone:623-594-7337
Practice Address - Fax:623-564-7340
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ34314208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ964438OtherAHHCCCS