Healthcare Provider Details

I. General information

NPI: 1144511262
Provider Name (Legal Business Name): FARAH JEHAN VILLANUEVA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FARAH JEHAN AKBAR D.O.

II. Dates (important events)

Enumeration Date: 04/23/2011
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 TORRANCE BLVD
TORRANCE CA
90503-4607
US

IV. Provider business mailing address

21311 MADRONA AVE STE 101
TORRANCE CA
90503-5970
US

V. Phone/Fax

Practice location:
  • Phone: 310-374-8191
  • Fax: 310-303-6834
Mailing address:
  • Phone: 310-792-4058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number20A12479
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: