Provider Demographics
NPI:1437403680
Name:VILLANUEVA, MARIA (LVN)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5066 N FRESNO ST
Mailing Address - Street 2:SUITE # 103
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-7615
Mailing Address - Country:US
Mailing Address - Phone:559-224-0299
Mailing Address - Fax:559-224-0155
Practice Address - Street 1:5066 N FRESNO ST
Practice Address - Street 2:SUITE # 103
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7615
Practice Address - Country:US
Practice Address - Phone:559-224-0299
Practice Address - Fax:559-224-0155
Is Sole Proprietor?:No
Enumeration Date:2012-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN199357164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse