Healthcare Provider Details

I. General information

NPI: 1275032773
Provider Name (Legal Business Name): BREANNA ALEXA VILLATORO B.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BREANNA ALEXA VILLATORO B.A.

II. Dates (important events)

Enumeration Date: 02/09/2018
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date: 09/27/2021
Reactivation Date: 10/18/2021

III. Provider practice location address

2621 OSWELL ST.
BAKERSFIELD CA
93306
US

IV. Provider business mailing address

P.O. BOX 1000
BAKERSFIELD CA
93302
US

V. Phone/Fax

Practice location:
  • Phone: 661-868-6956
  • Fax: 866-331-4283
Mailing address:
  • Phone: 661-868-6840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: