Healthcare Provider Details

I. General information

NPI: 1780161489
Provider Name (Legal Business Name): LUCIA MABASA VILLANUEVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LUCIA JARENCIO MABASA

II. Dates (important events)

Enumeration Date: 07/25/2018
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 14TH ST
RIVERSIDE CA
92501-3858
US

IV. Provider business mailing address

30300 ANTELOPE RD
MENIFEE CA
92584-9438
US

V. Phone/Fax

Practice location:
  • Phone: 951-924-9791
  • Fax: 951-924-9754
Mailing address:
  • Phone: 619-808-8402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number494300
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: