Provider Demographics
NPI:1710113113
Name:VILLANUEVA, PAULO (DC)
Entity Type:Individual
Prefix:DR
First Name:PAULO
Middle Name:
Last Name:VILLANUEVA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4940 W 99TH ST
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-3612
Mailing Address - Country:US
Mailing Address - Phone:310-259-7748
Mailing Address - Fax:626-575-1511
Practice Address - Street 1:15901 HAWTHORNE BLVD
Practice Address - Street 2:STE 420
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-5808
Practice Address - Country:US
Practice Address - Phone:626-575-1211
Practice Address - Fax:626-575-1511
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-31
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 30720111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor