Active NPI
Cresolito Alcantara Villanueva Jr.
- Family Nurse Practitioner
- Stockton, CA
National Provider Identifier
1083186639
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 95010695
- Practice address
- 2339 W Hammer LN
Stockton, CA 95209-2368 - Phone
- (209) 940-5901
- NPI assigned
- Dec 20, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 95010695 | CA | Primary |
Addresses
Primary practice location
2339 W Hammer LN
Stockton, CA 95209-2368
Mailing address
2339 W Hammer LN
Stockton, CA 95209-2368
Phone (209) 940-5901
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | cvillanueva1647983@oc.providencedirect.org | ||
| Direct Messaging Address | cvillanueva1647983@oc.providencedirect.org |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Alignment Healthcare Center | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinic/Center
- Modesto, CA
- NPI 1992194278
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1545264000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1636588800000",
"number": "1083186639",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2339 W HAMMER LN",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952092368",
"telephone_number": "209-940-5901"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2339 W HAMMER LN",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952092368",
"telephone_number": "209-940-5901"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VILLANUEVA",
"first_name": "CRESOLITO",
"middle_name": "ALCANTARA",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-12-20",
"last_updated": "2021-11-11",
"certification_date": "2021-11-11",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "CA",
"license": "95010695",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "cvillanueva1647983@oc.providencedirect.org",
"affiliation": "N",
"address_1": "1162 Montgomery Dr Fl 2",
"city": "Santa Rosa",
"state": "CA",
"country_code": "US",
"postal_code": "954054802",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "cvillanueva1647983@oc.providencedirect.org",
"affiliation": "N",
"address_1": "905 E Washington St",
"city": "Petaluma",
"state": "CA",
"country_code": "US",
"postal_code": "949523389",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Stockton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.