Provider Demographics
NPI:1679121727
Name:VILLAESCUSA, ROBERTA MARIA
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:MARIA
Last Name:VILLAESCUSA
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 1:743 W LAMARK DR
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92802-4012
Mailing Address - Country:US
Mailing Address - Phone:714-719-0192
Mailing Address - Fax:
Practice Address - Street 1:743 W LAMARK DR
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92802-4012
Practice Address - Country:US
Practice Address - Phone:714-719-0192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider