Individual
THEA VILLANUEVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
12900 PARK PLAZA DR STE 150, CERRITOS, CA 90703-9329
(866) 646-3553
(562) 622-3058
Mailing address
13520 PARK CENTRE ST, BALDWIN PARK, CA 91706-2265
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
23502
CA
Other
Enumeration date
11/04/2013
Last updated
01/10/2014
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