Basic Information
Provider Information | |||||||||
NPI: | 1194297622 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | VILLEGAS-PARKER | ||||||||
FirstName: | VIEVA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | B.S. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | VILLEGAS-PARKER | ||||||||
OtherFirstName: | VIEVA | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | B.S. | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 1820 S 25TH AVE | ||||||||
Address2: |   | ||||||||
City: | BROADVIEW | ||||||||
State: | IL | ||||||||
PostalCode: | 601552864 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7086810073 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1414 MAIN ST | ||||||||
Address2: |   | ||||||||
City: | MELROSE PARK | ||||||||
State: | IL | ||||||||
PostalCode: | 601603902 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7086810073 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/21/2018 | ||||||||
LastUpdateDate: | 12/21/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X |   |   | Y |   |   |   |   |
No ID Information.