Provider Demographics
NPI:1144657156
Name:VILLANO, MARC PALMONES (IDMT)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:PALMONES
Last Name:VILLANO
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1610 S DEER HEIGHTS RD
Mailing Address - Street 2:APT # L14
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99224-5191
Mailing Address - Country:US
Mailing Address - Phone:425-308-9586
Mailing Address - Fax:
Practice Address - Street 1:701 HOSPITAL LOOP BLDG 9000
Practice Address - Street 2:
Practice Address - City:FAIRCHILD AFB
Practice Address - State:WA
Practice Address - Zip Code:99011-8704
Practice Address - Country:US
Practice Address - Phone:509-247-5661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-04
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians