Healthcare Provider Details

I. General information

NPI: 1750834636
Provider Name (Legal Business Name): JOSHUA JAIME VILLARRUEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2016
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 WORKMAN ST
BAKERSFIELD CA
93307-6800
US

IV. Provider business mailing address

3433 W SHAW AVE STE 108
FRESNO CA
93711-3229
US

V. Phone/Fax

Practice location:
  • Phone: 559-558-4051
  • Fax:
Mailing address:
  • Phone: 559-558-4051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: