Provider Demographics
NPI:1235929456
Name:VILLASOR, VIENNA
Entity type:Individual
Prefix:
First Name:VIENNA
Middle Name:
Last Name:VILLASOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VIENNA
Other - Middle Name:
Other - Last Name:VILLASOR-QUIROZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:510 E MAGNOLIA ST STE 100
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-1850
Mailing Address - Country:US
Mailing Address - Phone:209-938-0831
Mailing Address - Fax:209-938-0849
Practice Address - Street 1:510 E MAGNOLIA ST STE 100
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-1850
Practice Address - Country:US
Practice Address - Phone:209-938-0831
Practice Address - Fax:209-938-0849
Is Sole Proprietor?:No
Enumeration Date:2025-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA672541163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse