Healthcare Provider Details

I. General information

NPI: 1518886852
Provider Name (Legal Business Name): DANIEL EMMANUEL VILLICANA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 ROLLINS RD
BURLINGAME CA
94010-2306
US

IV. Provider business mailing address

10680 CENTER AVE
GILROY CA
95020-9217
US

V. Phone/Fax

Practice location:
  • Phone: 408-430-9791
  • Fax: 408-430-9791
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberE146390
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: