Healthcare Provider Details

I. General information

NPI: 1720583958
Provider Name (Legal Business Name): KARIE GLENNYS VILLANUEVA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W CARSON ST
TORRANCE CA
90502-2059
US

IV. Provider business mailing address

1000 W CARSON ST, TORRANCE
TORRANCE CA
90502
US

V. Phone/Fax

Practice location:
  • Phone: 424-306-4000
  • Fax:
Mailing address:
  • Phone: 424-306-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberA164698
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: