Provider Demographics
NPI:1639944762
Name:VILLANUEVA, MARILYN PAGARITA (RN)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:PAGARITA
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2508 5TH AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90018-1878
Mailing Address - Country:US
Mailing Address - Phone:818-484-6486
Mailing Address - Fax:
Practice Address - Street 1:2508 5TH AVE APT 4
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90018-1878
Practice Address - Country:US
Practice Address - Phone:818-484-6486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA740515163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse