Healthcare Provider Details

I. General information

NPI: 1801750484
Provider Name (Legal Business Name): ALEJANDRA VILLANUEVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2277 W 390 N
PROVO UT
84601-7203
US

IV. Provider business mailing address

2277 W 390 N
PROVO UT
84601-7203
US

V. Phone/Fax

Practice location:
  • Phone: 801-376-0218
  • Fax: 801-376-0218
Mailing address:
  • Phone: 801-376-0218
  • Fax: 801-376-0218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: