Healthcare Provider Details

I. General information

NPI: 1982302998
Provider Name (Legal Business Name): ARCIE VILLANUEVA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3325 WILSHIRE BLVD STE 208
LOS ANGELES CA
90010-1733
US

IV. Provider business mailing address

3325 WILSHIRE BLVD STE 208
LOS ANGELES CA
90010-1733
US

V. Phone/Fax

Practice location:
  • Phone: 213-221-1272
  • Fax:
Mailing address:
  • Phone: 208-598-2350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95024059
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95024059
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95024059
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: