Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 95015031 | CA |
NPI | 1003494691 |
---|---|
Provider Name | Miss Janice Mae Villegas |
First Address | Duarte, CA 91010-3536 |
Second Address | Duarte, CA 91010-3536 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2021 |
Last Update Date | 01/04/2021 |