Healthcare Provider Details

I. General information

NPI: 1720933492
Provider Name (Legal Business Name): RAUL ULYSES VILLAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5074 OLD HWY N
MARIPOSA CA
95338-2430
US

IV. Provider business mailing address

15462 W A ST
KERMAN CA
93630-1241
US

V. Phone/Fax

Practice location:
  • Phone: 209-742-0260
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number0645298135
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number260172111
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: