Provider Demographics
NPI:1902305188
Name:VILLAPUDUA, ANTONIA BRINEE (LVN)
Entity type:Individual
Prefix:
First Name:ANTONIA
Middle Name:BRINEE
Last Name:VILLAPUDUA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:ANTONIA
Other - Middle Name:BRINEE
Other - Last Name:THACH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LVN
Mailing Address - Street 1:2220 CEMO CIR APT 7148
Mailing Address - Street 2:
Mailing Address - City:GOLD RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95670-8173
Mailing Address - Country:US
Mailing Address - Phone:209-818-9351
Mailing Address - Fax:
Practice Address - Street 1:2 N MARKET ST STE 300
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95113-1211
Practice Address - Country:US
Practice Address - Phone:510-210-3233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA712190164X00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician