Healthcare Provider Details

I. General information

NPI: 1942736186
Provider Name (Legal Business Name): ALEJANDRA VILLEGAS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2017
Last Update Date: 11/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2302 MERRILL CENTER DR
EL CENTRO CA
92243-7526
US

IV. Provider business mailing address

2435 MARSHALL AVE
IMPERIAL CA
92251-9599
US

V. Phone/Fax

Practice location:
  • Phone: 760-352-7756
  • Fax: 760-352-1926
Mailing address:
  • Phone: 760-550-6327
  • Fax: 760-550-6331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95006019
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: