Healthcare Provider Details

I. General information

NPI: 1689584641
Provider Name (Legal Business Name): KRYSTAL VILLATORO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 MABEL JOSEPHINE DR
TRACY CA
95377-6645
US

IV. Provider business mailing address

13924 MANSA DR
LA MIRADA CA
90638-3524
US

V. Phone/Fax

Practice location:
  • Phone: 209-830-3390
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number36180
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: