Healthcare Provider Details

I. General information

NPI: 1235045394
Provider Name (Legal Business Name): IRENE VILLAREAL LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARISOL LUCIA TRUJILLO LVN

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32869 STARLIGHT ST
WILDOMAR CA
92595-8085
US

IV. Provider business mailing address

32869 STARLIGHT ST
WILDOMAR CA
92595-8085
US

V. Phone/Fax

Practice location:
  • Phone: 626-366-4620
  • Fax:
Mailing address:
  • Phone: 626-367-4620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number260350
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: