Healthcare Provider Details

I. General information

NPI: 1922446111
Provider Name (Legal Business Name): CARLOS QUITO VILLANUEVA LVN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 06/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

739 EASTBURY DR
ESCONDIDO CA
92027-4010
US

IV. Provider business mailing address

739 EASTBURY DR
ESCONDIDO CA
92027-4010
US

V. Phone/Fax

Practice location:
  • Phone: 760-294-9773
  • Fax: 760-294-9481
Mailing address:
  • Phone: 760-294-9773
  • Fax: 760-294-9481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN1665990
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: