Healthcare Provider Details

I. General information

NPI: 1265907679
Provider Name (Legal Business Name): DAVID VILLARINO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2018
Last Update Date: 10/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11535 AVENUE 264
VISALIA CA
93277-9315
US

IV. Provider business mailing address

11535 AVENUE 264
VISALIA CA
93277-9315
US

V. Phone/Fax

Practice location:
  • Phone: 559-747-3984
  • Fax: 559-747-3642
Mailing address:
  • Phone: 559-747-3984
  • Fax: 559-747-3642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: