Healthcare Provider Details

I. General information

NPI: 1164718235
Provider Name (Legal Business Name): GEORGE VILLARRUEL CP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2011
Last Update Date: 01/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 L ST
SACRAMENTO CA
95816-5225
US

IV. Provider business mailing address

1700 N CHRISMAN RD
TRACY CA
95304-9314
US

V. Phone/Fax

Practice location:
  • Phone: 916-706-1520
  • Fax: 916-706-1551
Mailing address:
  • Phone: 800-726-9180
  • Fax: 209-834-1158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: