Basic Information
| Provider Information | |||||||||
| NPI: | 1356415616 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ZEPHYRENE C VILLALUZ MD CHTD | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1825 CIVIC CENTER DRIVE | ||||||||
| Address2: | |||||||||
| City: | N LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026428313 | ||||||||
| FaxNumber: | 7026428903 | ||||||||
| Practice Location | |||||||||
| Address1: | 1825 CIVIC CENTER DRIVE | ||||||||
| Address2: | |||||||||
| City: | N LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026428313 | ||||||||
| FaxNumber: | 7026428903 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | VILLALUZ | ||||||||
| AuthorizedOfficialFirstName: | ZEPHYRENE | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7026428313 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 6679 | NV | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2019236 | 05 | NV | MEDICAID |