MEDICARE: LOURDES VILLASENOR FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	16796	WI
2	363LF0000X	Family Nurse Practitioner	95009251	CA

General Provider Information

NPI Number	:	1215421433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOURDES VILLASENOR FNP

Provider Business Mailing Address
First Line	:	2163 W ESSEX CIR
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92804-4311
Country	:	US
Telephone Number	:	562-457-8703
Fax Number	:

Provider Business Practice Location Address
First Line	:	1520 N MOUNTAIN AVE STE 128
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91762-1132
Country	:	US
Telephone Number	:	909-949-9299
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2018
Last Update Date	:	06/10/2025

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