Provider Demographics
NPI:1225323702
Name:VILLANUEVA, VERONICA
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:
Other - Last Name:RENTERIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:427 C ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-5100
Mailing Address - Country:US
Mailing Address - Phone:619-238-4180
Mailing Address - Fax:619-238-4245
Practice Address - Street 1:427 C ST
Practice Address - Street 2:SUITE 212
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-5100
Practice Address - Country:US
Practice Address - Phone:619-238-4180
Practice Address - Fax:619-238-4245
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00152747376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide