Healthcare Provider Details

I. General information

NPI: 1043908320
Provider Name (Legal Business Name): YESENIA AVALOS-VILLANUEVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2023
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 HOMESTEAD RD
LOS ALTOS CA
94024-7339
US

IV. Provider business mailing address

10081 LYNDALE AVE
SAN JOSE CA
95127-3728
US

V. Phone/Fax

Practice location:
  • Phone: 408-774-0134
  • Fax: 408-774-9594
Mailing address:
  • Phone: 669-350-6375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number173767
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: