Healthcare Provider Details

I. General information

NPI: 1912739749
Provider Name (Legal Business Name): JOSEPH VILLAFUERTE NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 08/03/2025
Certification Date: 08/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4932 AVOCA ST
LOS ANGELES CA
90041-3106
US

IV. Provider business mailing address

4932 AVOCA ST
LOS ANGELES CA
90041-3106
US

V. Phone/Fax

Practice location:
  • Phone: 323-839-4684
  • Fax:
Mailing address:
  • Phone: 323-839-4684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95036431
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number771292
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: