Provider Demographics
NPI:1619561115
Name:VILLASENOR, MARIA (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:VILLASENOR
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5609 ALEXANDRIA AVE
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-7268
Mailing Address - Country:US
Mailing Address - Phone:951-415-6954
Mailing Address - Fax:
Practice Address - Street 1:1860 HAMNER AVE
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-2945
Practice Address - Country:US
Practice Address - Phone:951-479-0070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA750213163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse