Healthcare Provider Details

I. General information

NPI: 1336912047
Provider Name (Legal Business Name): ALEXANDRIA VILLARREAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2023
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 UNITED FOUNDERS BLVD STE 139E
OKLAHOMA CITY OK
73112-4359
US

IV. Provider business mailing address

520 POINTE PARKWAY BLVD
YUKON OK
73099-0600
US

V. Phone/Fax

Practice location:
  • Phone: 405-754-2499
  • Fax: 855-921-1883
Mailing address:
  • Phone: 405-818-1025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-91047
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: