Provider Demographics
NPI:1215421433
Name:VILLASENOR, LOURDES (FNP)
Entity type:Individual
Prefix:
First Name:LOURDES
Middle Name:
Last Name:VILLASENOR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2163 W ESSEX CIR
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-4311
Mailing Address - Country:US
Mailing Address - Phone:562-457-8703
Mailing Address - Fax:
Practice Address - Street 1:1520 N MOUNTAIN AVE STE 128
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-1132
Practice Address - Country:US
Practice Address - Phone:909-949-9299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95009251363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily