Provider Demographics
NPI:1942736186
Name:VILLEGAS, ALEJANDRA (FNP)
Entity Type:Individual
Prefix:
First Name:ALEJANDRA
Middle Name:
Last Name:VILLEGAS
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 1:2435 MARSHALL AVE
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:CA
Mailing Address - Zip Code:92251-9599
Mailing Address - Country:US
Mailing Address - Phone:760-550-6327
Mailing Address - Fax:760-550-6331
Practice Address - Street 1:2302 MERRILL CENTER DR
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-7526
Practice Address - Country:US
Practice Address - Phone:760-352-7756
Practice Address - Fax:760-352-1926
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-09
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95006019363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner