Individual
MR. ANTHONY FELIPE BANUELOS VILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
3437 ELLISON ST, LOS ANGELES, CA 90063-1901
(626) 375-5566
Mailing address
3437 ELLISON ST, LOS ANGELES, CA 90063-1901
(626) 375-5566
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
95014143
CA
Other
Enumeration date
03/26/2020
Last updated
03/26/2020
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