Provider Demographics
NPI:1265112023
Name:VILLANUEVA, EMILIO J
Entity type:Individual
Prefix:
First Name:EMILIO
Middle Name:J
Last Name:VILLANUEVA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 GONZAGA TER
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-4397
Mailing Address - Country:US
Mailing Address - Phone:530-204-9848
Mailing Address - Fax:
Practice Address - Street 1:2 MEDICAL PLAZA DR STE 175
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3049
Practice Address - Country:US
Practice Address - Phone:916-782-2146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95026068363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily