Provider Demographics
NPI:1093598765
Name:VILLANUEVA, GIAN
Entity Type:Individual
Prefix:
First Name:GIAN
Middle Name:
Last Name:VILLANUEVA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38443 TIMPANOGAS CIR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-1853
Mailing Address - Country:US
Mailing Address - Phone:408-890-8770
Mailing Address - Fax:
Practice Address - Street 1:38443 TIMPANOGAS CIR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-1853
Practice Address - Country:US
Practice Address - Phone:408-890-8770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician