Provider Demographics
NPI:1841035854
Name:VILLANUEVA GONZALEZ, ROBERT JR (NP)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:VILLANUEVA GONZALEZ
Suffix:JR
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38369 WINDINGWALK DR
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-0803
Mailing Address - Country:US
Mailing Address - Phone:909-587-0555
Mailing Address - Fax:
Practice Address - Street 1:38369 WINDINGWALK DR
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-0803
Practice Address - Country:US
Practice Address - Phone:909-587-0555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95029545363LF0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily