Healthcare Provider Details

I. General information

NPI: 1790139137
Provider Name (Legal Business Name): JANUARY VILLARREAL CCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 W IOWA AVE
SUNNYVALE CA
94086-5926
US

IV. Provider business mailing address

2471 LINCOLN AVE
SAN JOSE CA
95125-2751
US

V. Phone/Fax

Practice location:
  • Phone: 408-522-8267
  • Fax:
Mailing address:
  • Phone: 408-315-2006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number23951
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: