Provider Demographics
NPI:1205024171
Name:VILLEGAS, VIRGINIA (RNC, NP)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:VILLEGAS
Suffix:
Gender:F
Credentials:RNC, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 SIERRA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-2310
Mailing Address - Country:US
Mailing Address - Phone:310-291-7518
Mailing Address - Fax:
Practice Address - Street 1:4156 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90011-3154
Practice Address - Country:US
Practice Address - Phone:323-454-2388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17504363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health