Provider Demographics
NPI:1255118378
Name:JARCIA, MARITES VILLANUEVA
Entity type:Individual
Prefix:
First Name:MARITES
Middle Name:VILLANUEVA
Last Name:JARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARITES
Other - Middle Name:T
Other - Last Name:VILLANUEVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2785 E DIANA AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-4802
Mailing Address - Country:US
Mailing Address - Phone:714-803-8377
Mailing Address - Fax:
Practice Address - Street 1:2785 E DIANA AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-4802
Practice Address - Country:US
Practice Address - Phone:714-803-8377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility