Provider Demographics
NPI:1659020550
Name:VILLAFUERTE, GABRIELA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:GABRIELA
Middle Name:
Last Name:VILLAFUERTE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19387 CASCADE DR
Mailing Address - Street 2:
Mailing Address - City:TRABUCO CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:92679-1134
Mailing Address - Country:US
Mailing Address - Phone:714-425-7415
Mailing Address - Fax:
Practice Address - Street 1:19387 CASCADE DR
Practice Address - Street 2:
Practice Address - City:TRABUCO CANYON
Practice Address - State:CA
Practice Address - Zip Code:92679-1134
Practice Address - Country:US
Practice Address - Phone:714-425-7415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-20
Last Update Date:2022-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95020160207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine