Provider Demographics
NPI:1790264638
Name:VILLARREAL, LAURA JANETH (FNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:JANETH
Last Name:VILLARREAL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19947 VINTAGE ST
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-3555
Mailing Address - Country:US
Mailing Address - Phone:818-267-9346
Mailing Address - Fax:818-891-1747
Practice Address - Street 1:19947 VINTAGE ST
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-3555
Practice Address - Country:US
Practice Address - Phone:818-891-1745
Practice Address - Fax:818-891-1747
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF08180033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily