Provider Demographics
NPI:1144697871
Name:VILLANUEVA, LISANDRO (BA)
Entity type:Individual
Prefix:MR
First Name:LISANDRO
Middle Name:
Last Name:VILLANUEVA
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7425 RANCHO LOS GUILICOS RD
Mailing Address - Street 2:DEPT. B
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-6519
Mailing Address - Country:US
Mailing Address - Phone:707-565-8681
Mailing Address - Fax:
Practice Address - Street 1:7425 RANCHO LOS GUILICOS RD
Practice Address - Street 2:DEPT. B
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-6519
Practice Address - Country:US
Practice Address - Phone:707-565-8681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-28
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health