Healthcare Provider Details

I. General information

NPI: 1790525376
Provider Name (Legal Business Name): ISRAEL VILLALVAZO RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2024
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 SCHILLING PL
SALINAS CA
93901-4543
US

IV. Provider business mailing address

42 STONE ST UNIT 1
SALINAS CA
93901-2672
US

V. Phone/Fax

Practice location:
  • Phone: 831-809-9456
  • Fax: 831-775-8092
Mailing address:
  • Phone: 323-253-9756
  • Fax: 831-775-8092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number95186773
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: