Provider Demographics
NPI:1902305188
Name:VILLAPUDUA, ANTONIA BRINEE (RN)
Entity type:Individual
Prefix:
First Name:ANTONIA
Middle Name:BRINEE
Last Name:VILLAPUDUA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ANTONIA
Other - Middle Name:BRINEE
Other - Last Name:THACH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:1500 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-4523
Mailing Address - Country:US
Mailing Address - Phone:415-474-7310
Mailing Address - Fax:
Practice Address - Street 1:1500 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-4523
Practice Address - Country:US
Practice Address - Phone:415-474-7310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
CA712190164X00000X
CA95395478163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No164X00000XNursing Service ProvidersLicensed Vocational Nurse