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General NPI Number Information
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NPI Number | 1174704845
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Entity Type | Individual
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Provider Name | JOHNNY VILLANUEVA AGUSTIN NP
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Gender | Male
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Dates
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Enumeration Date | 11/21/2007
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Last Update Date | 12/29/2021
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Provider Practice Location Address
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Address Line | 565 KERN ST
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City | SHAFTER
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State | CA
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Zip | 93263-2133
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Country | US
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Telephone | 661-746-4937
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Fax |
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Provider Business Mailing Address
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Address Line | 403 BRIGHTSTONE DR
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City | BAKERSFIELD
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State | CA
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Zip | 93312-7032
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Country | US
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Telephone | 661-333-4997
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC1500X
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Taxonomy Name | Community Health Registered Nurse
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License Number | 536811
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95018599
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License Number State | CA
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