Provider Demographics
NPI:1144511262
Name:VILLANUEVA, FARAH JEHAN (DO)
Entity type:Individual
Prefix:
First Name:FARAH
Middle Name:JEHAN
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:FARAH
Other - Middle Name:JEHAN
Other - Last Name:AKBAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:21311 MADRONA AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-5970
Mailing Address - Country:US
Mailing Address - Phone:310-792-4058
Mailing Address - Fax:
Practice Address - Street 1:4101 TORRANCE BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4607
Practice Address - Country:US
Practice Address - Phone:310-374-8191
Practice Address - Fax:310-303-6834
Is Sole Proprietor?:No
Enumeration Date:2011-04-23
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A124792084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology