MEDICARE: JACQUELINE VILLANUEVA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1538651930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE VILLANUEVA

Provider Business Mailing Address
First Line	:	39899 BALENTINE DR STE 128
Second Line	:
City	:	NEWARK
State	:	CA
Zip	:	94560-5361
Country	:	US
Telephone Number	:	650-931-6300
Fax Number	:

Provider Business Practice Location Address
First Line	:	39899 BALENTINE DR STE 128
Second Line	:
City	:	NEWARK
State	:	CA
Zip	:	94560-5361
Country	:	US
Telephone Number	:	650-931-6300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2018
Last Update Date	:	10/13/2022

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Directions to “ JACQUELINE VILLANUEVA ” Practice Location

Language	Start Address	Practice Location

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