Provider Demographics
NPI:1457447302
Name:VILLEGAS, LYVIA MENDOZA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:LYVIA
Middle Name:MENDOZA
Last Name:VILLEGAS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:MRS
Other - First Name:LYVIA
Other - Middle Name:MENDOZA
Other - Last Name:VILLEGAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:1725 W 17TH ST BLDG 50
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-2316
Mailing Address - Country:US
Mailing Address - Phone:714-834-8350
Mailing Address - Fax:714-834-8361
Practice Address - Street 1:1725 W 17TH ST
Practice Address - Street 2:BUILDING 50
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-2316
Practice Address - Country:US
Practice Address - Phone:714-834-8350
Practice Address - Fax:714-834-8361
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF7595363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily