Healthcare Provider Details

I. General information

NPI: 1326955154
Provider Name (Legal Business Name): ADORA BUSTOS VILLAMEA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 MARI CT
VALLEJO CA
94589-1543
US

IV. Provider business mailing address

130 MARI CT
VALLEJO CA
94589-1543
US

V. Phone/Fax

Practice location:
  • Phone: 415-823-2930
  • Fax: 415-823-2930
Mailing address:
  • Phone: 415-823-2930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number260528
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: