Provider Demographics
NPI:1891190112
Name:VILLANUEVA, VANESSA (LND)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PMB # 79 P O BOX 70344
Mailing Address - Street 2:CENTRO MEDICO BO. MONACILLOS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8344
Mailing Address - Country:US
Mailing Address - Phone:787-480-2700
Mailing Address - Fax:787-764-3643
Practice Address - Street 1:CENTRO MEDICO BO MONACILLO
Practice Address - Street 2:CENTRO MEDICO BO MONACILLOS
Practice Address - City:SAN JUAN
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00936
Practice Address - Country:UM
Practice Address - Phone:787-480-2700
Practice Address - Fax:787-764-3643
Is Sole Proprietor?:No
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1196133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist