Provider Demographics
NPI:1780161489
Name:VILLANUEVA, LUCIA MABASA
Entity type:Individual
Prefix:
First Name:LUCIA
Middle Name:MABASA
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LUCIA
Other - Middle Name:JARENCIO
Other - Last Name:MABASA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30300 ANTELOPE RD
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-9438
Mailing Address - Country:US
Mailing Address - Phone:619-808-8402
Mailing Address - Fax:
Practice Address - Street 1:22445 ALESSANDRO BLVD STE 113-114
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-8358
Practice Address - Country:US
Practice Address - Phone:951-924-9791
Practice Address - Fax:951-924-9754
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA494300163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse