Provider Demographics
NPI:1679381669
Name:VILLANUEVA, JOANNA (NP)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:VILLANUEVA
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 1:14320 VENTURA BLVD # 308
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-2717
Mailing Address - Country:US
Mailing Address - Phone:818-599-3234
Mailing Address - Fax:
Practice Address - Street 1:14320 VENTURA BLVD # 308
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-2717
Practice Address - Country:US
Practice Address - Phone:818-599-3234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-21
Last Update Date:2024-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAG11240084363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner