Healthcare Provider Details

I. General information

NPI: 1528038932
Provider Name (Legal Business Name): NOHEA L VILLANUEVA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S SEASIDE AVE ISC SAN PEDRO MEDICAL
SAN PEDRO CA
90731-7333
US

IV. Provider business mailing address

COMDT (1122), U.S. COAST GUARD 2100 2ND ST SW SUITE 5314
WASHINGTON DC
20593-0001
US

V. Phone/Fax

Practice location:
  • Phone: 310-732-7500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: