Provider Demographics
NPI:1558926303
Name:VILLANUEVA, ALANNA
Entity Type:Individual
Prefix:
First Name:ALANNA
Middle Name:
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 1:4185 ISGRIGG ST
Mailing Address - Street 2:
Mailing Address - City:DUNSMUIR
Mailing Address - State:CA
Mailing Address - Zip Code:96025-1714
Mailing Address - Country:US
Mailing Address - Phone:805-708-2679
Mailing Address - Fax:
Practice Address - Street 1:555 N PERRIS BLVD
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-2811
Practice Address - Country:US
Practice Address - Phone:951-436-5300
Practice Address - Fax:951-436-5352
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-07
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1058731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical