Provider Demographics
NPI:1578104568
Name:LLAMAS, JONATHAN MARTIN VILLAFUERTE (DNP, RN-BC, PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN MARTIN
Middle Name:VILLAFUERTE
Last Name:LLAMAS
Suffix:
Gender:M
Credentials:DNP, RN-BC, PMHNP-BC
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Mailing Address - Street 1:3461 ATWATER AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-1915
Mailing Address - Country:US
Mailing Address - Phone:323-807-4237
Mailing Address - Fax:
Practice Address - Street 1:8920 WILSHIRE BLVD STE 425
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2004
Practice Address - Country:US
Practice Address - Phone:310-746-4395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-01
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95012704363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health