Provider Demographics
NPI:1053039529
Name:VILLENA, ANN BERNICE MENDOZA (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:ANN BERNICE
Middle Name:MENDOZA
Last Name:VILLENA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91755-1709
Mailing Address - Country:US
Mailing Address - Phone:626-280-0676
Mailing Address - Fax:626-280-2694
Practice Address - Street 1:120 E EMERSON AVE
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91755-1709
Practice Address - Country:US
Practice Address - Phone:626-280-0676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-19
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95021165363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily