Provider Demographics
NPI:1750913661
Name:VILLEGAS, MARY ANN THERESA (RN)
Entity type:Individual
Prefix:
First Name:MARY ANN
Middle Name:THERESA
Last Name:VILLEGAS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MARY ANN
Other - Middle Name:THERESA
Other - Last Name:METZGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:6 CENTERPOINTE DR
Mailing Address - Street 2:
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-2503
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6 CENTERPOINTE DR
Practice Address - Street 2:
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-2503
Practice Address - Country:US
Practice Address - Phone:844-937-8679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-08
Last Update Date:2020-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA569681163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health