Provider Demographics
NPI:1437319977
Name:CHAN-VILLANUEVA, IMELDA V (MD)
Entity type:Individual
Prefix:DR
First Name:IMELDA
Middle Name:V
Last Name:CHAN-VILLANUEVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:IMELDA
Other - Middle Name:C
Other - Last Name:VILLANUEVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4421 STATE HIGHWAY 6 S STE 100
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-6176
Mailing Address - Country:US
Mailing Address - Phone:979-690-4828
Mailing Address - Fax:979-690-4829
Practice Address - Street 1:4421 STATE HIGHWAY 6 S STE 100
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-6176
Practice Address - Country:US
Practice Address - Phone:979-690-4828
Practice Address - Fax:979-690-4829
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0685207Q00000X
VA0101243329207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine