Healthcare Provider Details

I. General information

NPI: 1891222618
Provider Name (Legal Business Name): SVETLANA VILLANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 ZONAL AVE
LOS ANGELES CA
90089-0121
US

IV. Provider business mailing address

2020 ZONAL AVE
LOS ANGELES CA
90089-0121
US

V. Phone/Fax

Practice location:
  • Phone: 323-409-1000
  • Fax:
Mailing address:
  • Phone: 702-388-8436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number20A18295
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: