Provider Demographics
NPI:1053167312
Name:VILLACRUCIS, ALEGRIA AMOR GELLOR (NP)
Entity type:Individual
Prefix:
First Name:ALEGRIA AMOR
Middle Name:GELLOR
Last Name:VILLACRUCIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-1816
Mailing Address - Country:US
Mailing Address - Phone:213-550-8777
Mailing Address - Fax:
Practice Address - Street 1:1608 3RD ST
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-1816
Practice Address - Country:US
Practice Address - Phone:213-550-8777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-27
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA760958163W00000X
CA95029858363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty