Healthcare Provider Details

I. General information

NPI: 1215345103
Provider Name (Legal Business Name): MR. LEONARD ANTHONY VILLAFUERTE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2014
Last Update Date: 07/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 STEWART DRIVE SUITE 29
SUNNYVALE CA
94085
US

IV. Provider business mailing address

1111 W. EL CAMINO REAL 109-385
SUNNYVALE CA
94087
US

V. Phone/Fax

Practice location:
  • Phone: 408-913-9233
  • Fax:
Mailing address:
  • Phone: 408-368-1155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberCPT00013357
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: