Healthcare Provider Details

I. General information

NPI: 1073019501
Provider Name (Legal Business Name): MARIA KATRINA FAUSTINO VILLANUEVA M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 S MAIN ST
WALNUT CREEK CA
94596-5318
US

IV. Provider business mailing address

1425 S MAIN ST
WALNUT CREEK CA
94596-5318
US

V. Phone/Fax

Practice location:
  • Phone: 925-295-4000
  • Fax:
Mailing address:
  • Phone: 475-279-8382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC210189
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: