Provider Demographics
NPI:1598507907
Name:VILLA, MARC BRYAN DENIEGA (BSN RN)
Entity type:Individual
Prefix:MR
First Name:MARC BRYAN
Middle Name:DENIEGA
Last Name:VILLA
Suffix:
Gender:M
Credentials:BSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10301 BOUVAIS RD
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-5615
Mailing Address - Country:US
Mailing Address - Phone:714-270-9087
Mailing Address - Fax:
Practice Address - Street 1:10301 BOUVAIS RD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-5615
Practice Address - Country:US
Practice Address - Phone:714-270-9087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95318893163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse