Individual
KELLI VILLANUEVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2629 GRAMBLING CT, DAVIS, CA 95618-2576
(530) 400-7636
Mailing address
PO BOX 4436, DAVIS, CA 95617-4436
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
574700009
CA
Other
Enumeration date
03/06/2019
Last updated
03/06/2019
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