Healthcare Provider Details

I. General information

NPI: 1093651549
Provider Name (Legal Business Name): JESSICA NATALIE VILLANUEVA REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 CARMEN LN STE A
SANTA MARIA CA
93458-7768
US

IV. Provider business mailing address

14176 FOOTHILL BLVD
SYLMAR CA
91342-7566
US

V. Phone/Fax

Practice location:
  • Phone: 805-348-1850
  • Fax:
Mailing address:
  • Phone: 310-951-3001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number95450319
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95450319
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95450319
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: