Basic Information
| Provider Information | |||||||||
| NPI: | 1124327226 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUANA | ||||||||
| FirstName: | OWEN | ||||||||
| MiddleName: | VILLAGONZALO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MUANA | ||||||||
| OtherFirstName: | OWEN NINO | ||||||||
| OtherMiddleName: | VILLAGONZALO | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3960 TURNPIKE ROAD | ||||||||
| Address2: | JENCARE NEIGHBORHOOD MEDICAL CENTER VICTORY, LLC | ||||||||
| City: | PORTSMOUTH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7573931136 | ||||||||
| FaxNumber: | 7573935534 | ||||||||
| Practice Location | |||||||||
| Address1: | 3960 TURNPIKE ROAD | ||||||||
| Address2: | JENCARE NEIGHBORHOOD MEDICAL CENTER VICTORY, LLC | ||||||||
| City: | PORTSMOUTH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7573931136 | ||||||||
| FaxNumber: | 7573935534 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2011 | ||||||||
| LastUpdateDate: | 07/21/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 259838 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 16046 | HI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.