Healthcare Provider Details

I. General information

NPI: 1720414345
Provider Name (Legal Business Name): MR. LUIS VILLARREAL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2013
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 E MOUNTAIN VIEW ST STE 100
BARSTOW CA
92311-2814
US

IV. Provider business mailing address

309 E MOUNTAIN VIEW ST STE 100
BARSTOW CA
92311-2814
US

V. Phone/Fax

Practice location:
  • Phone: 760-248-6612
  • Fax:
Mailing address:
  • Phone: 760-248-6612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13214
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: