Healthcare Provider Details

I. General information

NPI: 1750234167
Provider Name (Legal Business Name): DAELENE ZETA VILLANUEVA CABAHUG CPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2026
Last Update Date: 02/16/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 E 238TH PL
CARSON CA
90745-5832
US

IV. Provider business mailing address

351 E 238TH PL
CARSON CA
90745-5832
US

V. Phone/Fax

Practice location:
  • Phone: 310-971-8678
  • Fax:
Mailing address:
  • Phone: 310-971-8678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number02530627
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: