Doctor Name: | JESSE VILLANUEVA |
NPI Number: | 1255737631 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 5841 |
Business Practice Address: | 10 Washington Ave East Haven, CT - 065123776 |
Business Phone Number: | 2039803782 |
Business Fax Number: | |
Mailing Address: | 10 Washington Ave, EAST HAVEN |
State: | CT |
Postal Code: | 065123776 |
Phone Number: | 2039803782 |
Fax Number: | |
NPI Enumeration Date: | 11/12/2014 |
NPI Last Update Date: | 03/13/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 5841 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |