Provider Demographics
NPI:1225219942
Name:VILLANUEVA, NELIDA I
Entity Type:Individual
Prefix:
First Name:NELIDA
Middle Name:I
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3311 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-7007
Mailing Address - Country:US
Mailing Address - Phone:925-373-5313
Mailing Address - Fax:925-373-5034
Practice Address - Street 1:3311 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-7007
Practice Address - Country:US
Practice Address - Phone:925-373-5313
Practice Address - Fax:925-373-5034
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator