Healthcare Provider Details

I. General information

NPI: 1164349247
Provider Name (Legal Business Name): JONAS LOUIS MALAZARTE VILLANUEVA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 BEVERLY BLVD
WEST HOLLYWOOD CA
90048-1804
US

IV. Provider business mailing address

8700 BEVERLY BLVD
WEST HOLLYWOOD CA
90048-1804
US

V. Phone/Fax

Practice location:
  • Phone: 310-200-9687
  • Fax:
Mailing address:
  • Phone: 310-200-9687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95037592
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: