Provider Demographics
NPI:1033554266
Name:VILLAFUERTE, EULOGIA ANANIAH
Entity Type:Individual
Prefix:
First Name:EULOGIA
Middle Name:ANANIAH
Last Name:VILLAFUERTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GIA
Other - Middle Name:
Other - Last Name:VILLAFUERTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9955 DE SOTO AVE APT 24
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-4223
Mailing Address - Country:US
Mailing Address - Phone:831-345-9085
Mailing Address - Fax:
Practice Address - Street 1:9955 DE SOTO AVE APT 24
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-4223
Practice Address - Country:US
Practice Address - Phone:831-345-9085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator