Provider Demographics
NPI:1164078358
Name:VILLANUEVA, KAREN JANE (RN, LAC, DAIMC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:JANE
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:RN, LAC, DAIMC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166B JOHN ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-4706
Mailing Address - Country:US
Mailing Address - Phone:510-221-6387
Mailing Address - Fax:
Practice Address - Street 1:5220 CLAREMONT AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1033
Practice Address - Country:US
Practice Address - Phone:510-428-3226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA556391163W00000X
CA18311171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse