Healthcare Provider Details

I. General information

NPI: 1851892905
Provider Name (Legal Business Name): ISAIAH VILLINES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2018
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W BRIGGSMORE AVE BLDG A
MODESTO CA
95350-3839
US

IV. Provider business mailing address

12128 W RIPON RD
RIPON CA
95366-9614
US

V. Phone/Fax

Practice location:
  • Phone: 209-526-1476
  • Fax:
Mailing address:
  • Phone: 209-450-6435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: