Basic Information
| Provider Information | |||||||||
| NPI: | 1710307822 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ERGUIZA | ||||||||
| FirstName: | RANDULF | ||||||||
| MiddleName: | VILLANUEVA | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MS, NP, FNP-BC, NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31625 HIGHWAY 101 S | ||||||||
| Address2: | |||||||||
| City: | SOLEDAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939609529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316785500 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 31625 HIGHWAY 101 S | ||||||||
| Address2: | |||||||||
| City: | SOLEDAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939609529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316785500 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2014 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 95000631 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.