Healthcare Provider Details

I. General information

NPI: 1568077071
Provider Name (Legal Business Name): AMBER VILLAGANTE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMBER MOTTOLA FNP

II. Dates (important events)

Enumeration Date: 09/11/2020
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 CLARK AVE # A
LONG BEACH CA
90815-2521
US

IV. Provider business mailing address

100 S ALAMEDA ST UNIT 224
LOS ANGELES CA
90012-3935
US

V. Phone/Fax

Practice location:
  • Phone: 562-997-1000
  • Fax:
Mailing address:
  • Phone: 917-846-0230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95016012
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: