Healthcare Provider Details

I. General information

NPI: 1306298013
Provider Name (Legal Business Name): MR. JOSE P VILLARRUEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2016
Last Update Date: 07/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3590 JUBILANT PL
COLORADO SPRINGS CO
80917-2513
US

IV. Provider business mailing address

3590 JUBILANT PL
COLORADO SPRINGS CO
80917-2513
US

V. Phone/Fax

Practice location:
  • Phone: 719-491-0691
  • Fax: 719-591-2140
Mailing address:
  • Phone: 719-491-0691
  • Fax: 719-591-2140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number21547
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: