MEDICARE: SARAH SANGALANG 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	163WP0809X	Adult Psychiatric/Mental Health Registered Nurse	628482	CA

General Provider Information

NPI Number	:	1780139220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH SANGALANG VILLANUEVA

Provider Business Mailing Address
First Line	:	1625 CHALCEDONY ST
Second Line	:	#205
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-3169
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1625 CHALCEDONY ST
Second Line	:	205
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-3169
Country	:	US
Telephone Number	:	714-606-5149
Fax Number	:

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

Provider Enumeration Date	:	08/24/2016
Last Update Date	:	08/24/2016

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