Provider Demographics
NPI:1427132620
Name:VILLANUEVA, GEORGE (DO)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:VILLANUEVA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 AVOCADO AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571
Mailing Address - Country:US
Mailing Address - Phone:951-657-0544
Mailing Address - Fax:951-657-9644
Practice Address - Street 1:126 AVOCADO AVE STE 207
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571
Practice Address - Country:US
Practice Address - Phone:951-657-0544
Practice Address - Fax:951-657-9644
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6023207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX60234Medicaid
CA00AX60234Medicaid
CA020A60230Medicare ID - Type Unspecified