Healthcare Provider Details

I. General information

NPI: 1528844164
Provider Name (Legal Business Name): MELISSA M VILLANUEVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 12/02/2025
Certification Date: 09/07/2023
Deactivation Date: 09/15/2025
Reactivation Date: 12/02/2025

III. Provider practice location address

1771 3RD ST
NORCO CA
92860-2670
US

IV. Provider business mailing address

996 ROYAL MARCO WAY
MARCO ISLAND FL
34145-1829
US

V. Phone/Fax

Practice location:
  • Phone: 951-750-7453
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: