Raymund Black Villanueva, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

95250016 Issued in CA

Practice address

4441 E Kings Canyon Rd
Fresno, CA 93702-3604

Phone

(559) 600-9180

NPI assigned

Nov 17, 2023

Reactivated

Oct 22, 2024

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1700179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729555200000",
    "number": "1255106423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5601 SPRING CREEK WAY",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "957587700",
            "telephone_number": "916-602-9009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4441 E KINGS CANYON RD",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937023604",
            "telephone_number": "559-600-9180"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2719 N Air Fresno Dr",
            "address_purpose": "LOCATION",
            "city": "Fresno",
            "state": "CA",
            "postal_code": "937271547",
            "country_code": "US",
            "telephone_number": "559-600-9180",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VILLANUEVA",
        "first_name": "RAYMUND",
        "middle_name": "BLACK",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-11-17",
        "last_updated": "2024-10-22",
        "certification_date": "2023-11-17",
        "deactivation_date": "2024-02-22",
        "reactivation_date": "2024-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "95250016",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alyssa Marie Villanueva
• Angelica Villanueva
• Ivan Villanueva
• Kristopher Glenn Villanueva
• Maria Villanueva, LVN
• Trina Lisa Villanueva, LMFT
• Alex Villar
• Monica Villar, LMFT
• Brittany Villarama, RN
• Kevin Ladines Villarama, OD

• Registered Nurse in Fresno, CA
• Providers in Fresno, CA by specialty
• Registered Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.