Provider Demographics
NPI:1861381279
Name:VILLANUEVA RAMIREZ, MICHAEL ANGELO (RDH)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANGELO
Last Name:VILLANUEVA RAMIREZ
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3614 ELM ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-1511
Mailing Address - Country:US
Mailing Address - Phone:619-483-8093
Mailing Address - Fax:
Practice Address - Street 1:2000 PHYSICIANS BLVD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-1277
Practice Address - Country:US
Practice Address - Phone:833-678-2781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102796126800000X
CA34127124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
No126800000XDental ProvidersDental Assistant