Provider Demographics
NPI:1962089763
Name:DACASIN, RAFFIE VILLANUEVA (BSN, MSN, APRN, NP-C)
Entity type:Individual
Prefix:MR
First Name:RAFFIE
Middle Name:VILLANUEVA
Last Name:DACASIN
Suffix:
Gender:M
Credentials:BSN, MSN, APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9890 CAPE VERDE DR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-6329
Mailing Address - Country:US
Mailing Address - Phone:661-932-8129
Mailing Address - Fax:
Practice Address - Street 1:9890 CAPE VERDE DR
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-6329
Practice Address - Country:US
Practice Address - Phone:661-932-8129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016944363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily