Individual
ENRIQUE VILLANUEVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SOIDC
Contact information
Practice address
BLDG 210730 C STREET, CAMP PENDLETON, CA 92055-5243
(407) 433-7822
Mailing address
PO BOX 555243, CAMP PENDLETON, CA 92055-5243
(407) 433-7822
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
01/06/2022
Last updated
01/06/2022
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