Healthcare Provider Details

I. General information

NPI: 1770496903
Provider Name (Legal Business Name): MELANY VILLARRUEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4740 GREEN RIVER RD
CORONA CA
92878-9185
US

IV. Provider business mailing address

16586 WINDCREST DR
FONTANA CA
92337-0874
US

V. Phone/Fax

Practice location:
  • Phone: 502-632-0885
  • Fax:
Mailing address:
  • Phone: 909-401-6567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: