Healthcare Provider Details

I. General information

NPI: 1073036489
Provider Name (Legal Business Name): NINA RICHIE BALAJADIA VILLANUEVA-CARPIO RN, PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2017
Last Update Date: 07/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 W MAGNOLIA BLVD
BURBANK CA
91506-1811
US

IV. Provider business mailing address

1101 W MAGNOLIA BLVD
BURBANK CA
91506-1811
US

V. Phone/Fax

Practice location:
  • Phone: 213-327-4320
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number659799
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: