Healthcare Provider Details

I. General information

NPI: 1184055352
Provider Name (Legal Business Name): MISS ANGELA VILLAREAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2013
Last Update Date: 12/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6688 ALHAMBRA AVE
MARTINEZ CA
94553-6105
US

IV. Provider business mailing address

51 HEALY LN
MARTINEZ CA
94553-2162
US

V. Phone/Fax

Practice location:
  • Phone: 310-613-5682
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number66073
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: