Healthcare Provider Details

I. General information

NPI: 1326176454
Provider Name (Legal Business Name): KATRINA DYSTANY VILLEGAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATRINA DYSTANY FLORES

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 BANCROFT AVE STE 267
OAKLAND CA
94605-2408
US

IV. Provider business mailing address

PO BOX 1000
BAKERSFIELD CA
93302-1000
US

V. Phone/Fax

Practice location:
  • Phone: 510-735-0864
  • Fax:
Mailing address:
  • Phone: 661-868-6601
  • Fax: 661-868-6666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: