Provider Demographics
NPI:1386286649
Name:ARTENCIO VILLANI, MARIA AUGUSTA (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MRS
First Name:MARIA AUGUSTA
Middle Name:
Last Name:ARTENCIO VILLANI
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:630 MASSELIN AVE APT 107
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-5759
Mailing Address - Country:US
Mailing Address - Phone:323-715-2764
Mailing Address - Fax:
Practice Address - Street 1:8660 WOODLEY AVE # 104
Practice Address - Street 2:
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343-5745
Practice Address - Country:US
Practice Address - Phone:818-894-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT293686225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist