Healthcare Provider Details

I. General information

NPI: 1912855768
Provider Name (Legal Business Name): JENNIFER VILLANUEVA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2026
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 GILMAN RD
EL MONTE CA
91732-3201
US

IV. Provider business mailing address

410 EDWIN ALDRIN CIR
MONTEBELLO CA
90640-3517
US

V. Phone/Fax

Practice location:
  • Phone: 626-705-9533
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number559936
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: