Individual
DR. PURITA Z VILLANUEVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
609 E ORANGEBURG AVE, SUITE 201, MODESTO, CA 95350-5512
(209) 572-3224
(209) 572-4528
Mailing address
609 E ORANGEBURG AVE, SUITE 201, MODESTO, CA 95350-5512
(209) 572-3224
(209) 572-4528
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
A44551
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CD278Z
MEDICARE PTAN
CA
01
—
P00392834
RAILROAD MEDICARE
CA
01
—
ZZZ48224Z
MEDICARE IDENTIFICATION #
CA
Enumeration date
10/17/2006
Last updated
10/01/2009
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