Provider Demographics
NPI:1366798019
Name:VILLANUEVA, JESSIE SABAS (PRIMARY CAREGIVER)
Entity type:Individual
Prefix:MR
First Name:JESSIE
Middle Name:SABAS
Last Name:VILLANUEVA
Suffix:
Gender:M
Credentials:PRIMARY CAREGIVER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-326 HENE ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-1301
Mailing Address - Country:US
Mailing Address - Phone:808-676-9418
Mailing Address - Fax:808-676-9418
Practice Address - Street 1:94-326 HENE ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-1301
Practice Address - Country:US
Practice Address - Phone:808-676-9418
Practice Address - Fax:808-676-9418
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIHI081013513376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide