Provider Demographics
NPI:1972934628
Name:VILLAFLORES, MAE BELLE
Entity Type:Individual
Prefix:
First Name:MAE BELLE
Middle Name:
Last Name:VILLAFLORES
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 1:7519 TULARE ST
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-1942
Mailing Address - Country:US
Mailing Address - Phone:714-860-0163
Mailing Address - Fax:
Practice Address - Street 1:7519 TULARE ST
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-1942
Practice Address - Country:US
Practice Address - Phone:714-860-0163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-05
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA275729164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse