Provider Demographics
NPI:1912534033
Name:VILLA, ANTHONY FELIPE BANUELOS (FNP)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:FELIPE BANUELOS
Last Name:VILLA
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 1:3437 ELLISON ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90063-1901
Mailing Address - Country:US
Mailing Address - Phone:626-375-5566
Mailing Address - Fax:
Practice Address - Street 1:3437 ELLISON ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90063-1901
Practice Address - Country:US
Practice Address - Phone:626-375-5566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95014143363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily