Provider Demographics
NPI:1881377463
Name:VILLANUEVA, MONIQUE ANTOINETTE
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:ANTOINETTE
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 SIMMONS ST APT 2096
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-1559
Mailing Address - Country:US
Mailing Address - Phone:661-483-6175
Mailing Address - Fax:
Practice Address - Street 1:1915 SIMMONS ST APT 2096
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-1559
Practice Address - Country:US
Practice Address - Phone:661-483-6175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-09
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT-25-447687106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician