Healthcare Provider Details

I. General information

NPI: 1497899710
Provider Name (Legal Business Name): HECTOR VILLANUEVA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 N LARK ELLEN AVE
WEST COVINA CA
91791-1069
US

IV. Provider business mailing address

10149 WATERFORD LN
ALTA LOMA CA
91737-2313
US

V. Phone/Fax

Practice location:
  • Phone: 626-339-5451
  • Fax:
Mailing address:
  • Phone: 909-980-7748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA043489
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: