Healthcare Provider Details

I. General information

NPI: 1063975639
Provider Name (Legal Business Name): ROBERT VILLALPANDO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 04/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8555 FLORENCE AVE
DOWNEY CA
90240-4014
US

IV. Provider business mailing address

1320 S PROSPERO DR
GLENDORA CA
91740-4965
US

V. Phone/Fax

Practice location:
  • Phone: 562-923-9351
  • Fax:
Mailing address:
  • Phone: 626-261-8683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number18986
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: