Healthcare Provider Details

I. General information

NPI: 1972129658
Provider Name (Legal Business Name): MR. CLIFFORD R VILLAFLOR SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2020
Last Update Date: 06/18/2020
Certification Date: 06/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18800 AMAR RD STE B16
WALNUT CA
91789-7101
US

IV. Provider business mailing address

18800 AMAR RD STE B16
WALNUT CA
91789-7101
US

V. Phone/Fax

Practice location:
  • Phone: 626-272-2754
  • Fax: 626-236-4146
Mailing address:
  • Phone: 626-272-2754
  • Fax: 626-236-4146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WV0202X
TaxonomyVehicle Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: