Provider Demographics
NPI:1932835246
Name:VILLANUEVA, LETICIA (CARE GIVER)
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:CARE GIVER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3806 MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79930-6322
Mailing Address - Country:US
Mailing Address - Phone:915-259-2216
Mailing Address - Fax:
Practice Address - Street 1:6812 FIRST ST
Practice Address - Street 2:
Practice Address - City:CANUTILLO
Practice Address - State:TX
Practice Address - Zip Code:79835-5417
Practice Address - Country:US
Practice Address - Phone:915-256-2058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide