Individual
FE TENIENTE VILLAFLOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1123 E DOMINGUEZ ST, BLDG. B & C, CARSON, CA 90746-3567
(310) 763-4998
Mailing address
732 VIEW LN, DIAMOND BAR, CA 91765-1896
(909) 957-8868
(909) 895-7570
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
MTN01096F
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MTN01096F
NON EMERGENCY TRANSPORTATION/ WHEELCHAIR VAN
CA
Enumeration date
07/27/2008
Last updated
07/27/2008
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