Provider Demographics
NPI:1689625303
Name:VILLENA, ANNA LIZA D (NP)
Entity Type:Individual
Prefix:DR
First Name:ANNA LIZA
Middle Name:D
Last Name:VILLENA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1761 ROXBURY ROAD
Mailing Address - Street 2:
Mailing Address - City:UPPER ARLINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43212
Mailing Address - Country:US
Mailing Address - Phone:510-367-2239
Mailing Address - Fax:
Practice Address - Street 1:616 16TH ST
Practice Address - Street 2:DOWNTOWN OAKLAND CLINIC
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-1205
Practice Address - Country:US
Practice Address - Phone:510-451-4270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10087363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily