Healthcare Provider Details

I. General information

NPI: 1720201858
Provider Name (Legal Business Name): MR. RAMIRO M. VILLANUEVA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14277 ROAD 28
MADERA CA
93638-5715
US

IV. Provider business mailing address

14277 ROAD 28
MADERA CA
93638-5715
US

V. Phone/Fax

Practice location:
  • Phone: 559-637-3508
  • Fax: 559-661-2818
Mailing address:
  • Phone: 559-637-3508
  • Fax: 559-661-2818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225CA2400X
TaxonomyAssistive Technology Practitioner Rehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: