Provider Demographics
NPI:1700335494
Name:PASTORES, ALFONSO VILLANUEVA (FNP)
Entity Type:Individual
Prefix:
First Name:ALFONSO
Middle Name:VILLANUEVA
Last Name:PASTORES
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11890 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-5806
Mailing Address - Country:US
Mailing Address - Phone:562-376-0176
Mailing Address - Fax:
Practice Address - Street 1:11890 PARK AVE
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-5806
Practice Address - Country:US
Practice Address - Phone:562-376-0176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005026363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily