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General NPI Number Information
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NPI Number | 1376700872
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Entity Type | Individual
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Provider Name | MRS. ERENEA DAR JUAN VILLANUEVA
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Gender | Female
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Dates
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Enumeration Date | 05/21/2008
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Last Update Date | 05/21/2008
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Provider Practice Location Address
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Address Line | 3113 BIG DALTON AVE UNIT B
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City | BALDWIN PARK
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State | CA
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Zip | 91706-5106
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Country | US
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Telephone | 626-475-2296
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Fax | 626-962-7371
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Provider Business Mailing Address
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Address Line | 3113 BIG DALTON AVE UNIT B
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City | BALDWIN PARK
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State | CA
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Zip | 91706-5106
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Country | US
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Telephone | 626-475-2296
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Fax | 626-962-7371
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 991572
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License Number State | CA
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