Provider Demographics
NPI:1568444982
Name:VILLACORTA, SARA INGRID (CNM)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:INGRID
Last Name:VILLACORTA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2256 GLOVER PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-1129
Mailing Address - Country:US
Mailing Address - Phone:619-955-3506
Mailing Address - Fax:
Practice Address - Street 1:2256 GLOVER PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90031-1129
Practice Address - Country:US
Practice Address - Phone:619-955-3506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-20
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA538013163W00000X
CA1833367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse