Healthcare Provider Details

I. General information

NPI: 1023835139
Provider Name (Legal Business Name): JASON VILLARUZ EMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2024
Last Update Date: 09/21/2024
Certification Date: 09/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W MISSION ST
SAN JOSE CA
95110-1701
US

IV. Provider business mailing address

37164 SAINT CHRISTOPHER ST
NEWARK CA
94560-3215
US

V. Phone/Fax

Practice location:
  • Phone: 707-246-3971
  • Fax:
Mailing address:
  • Phone: 707-246-3971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberE3690513
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: