Provider Demographics
NPI:1922446111
Name:VILLANUEVA, CARLOS QUITO (LVN)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:QUITO
Last Name:VILLANUEVA
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:739 EASTBURY DR
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92027-4010
Mailing Address - Country:US
Mailing Address - Phone:760-294-9773
Mailing Address - Fax:760-294-9481
Practice Address - Street 1:739 EASTBURY DR
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92027-4010
Practice Address - Country:US
Practice Address - Phone:760-294-9773
Practice Address - Fax:760-294-9481
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN1665990164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse