Provider Demographics
NPI:1891189049
Name:VILLANUEVA, ALEJANDRA IVETTE
Entity Type:Individual
Prefix:
First Name:ALEJANDRA
Middle Name:IVETTE
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2139 E 27TH ST
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-3374
Mailing Address - Country:US
Mailing Address - Phone:209-326-7968
Mailing Address - Fax:
Practice Address - Street 1:2139 E 27TH ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-3374
Practice Address - Country:US
Practice Address - Phone:209-326-7968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA257379164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse