Healthcare Provider Details

I. General information

NPI: 1780828780
Provider Name (Legal Business Name): ANDREE VILLANUEVA TROMPETA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2009
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18433 ROSCOE BLVD STE 104
NORTHRIDGE CA
91325-4127
US

IV. Provider business mailing address

18433 ROSCOE BLVD STE 104
NORTHRIDGE CA
91325-4127
US

V. Phone/Fax

Practice location:
  • Phone: 818-993-9555
  • Fax: 818-993-4803
Mailing address:
  • Phone: 818-993-9555
  • Fax: 818-993-4803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA125751
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: