Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | A26716 | CA |
NPI | 1174561401 |
---|---|
Provider Name | Benito Villanueva |
First Address | La Jolla, CA 92037-1224 |
Second Address | La Jolla, CA 92037-1224 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 06/05/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
26-2105023 | TAX ID (01) | CA |
A24930 | (02) |