Individual
NELSON MANRIQUE VILLALTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OPTICIAN
Contact information
Practice address
6529 SEVILLE AVE, HUNTINGTON PARK, CA 90255-4208
(323) 582-5770
Mailing address
6529 SEVILLE AVE, HUNTINGTON PARK, CA 90255-4208
(323) 582-5770
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
—
—
Other
Enumeration date
10/04/2019
Last updated
10/04/2019
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