Provider Demographics
NPI:1487824975
Name:VILLANUEVA, LEE CAMARILLO (MD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:CAMARILLO
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LEE
Other - Middle Name:ERNESTINE
Other - Last Name:VILLANUEVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2023 VALE RD STE 107
Mailing Address - Street 2:
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-3891
Mailing Address - Country:US
Mailing Address - Phone:510-412-9867
Mailing Address - Fax:
Practice Address - Street 1:2023 VALE RD STE 107
Practice Address - Street 2:
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3891
Practice Address - Country:US
Practice Address - Phone:510-215-9092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA104912207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine