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General NPI Number Information
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NPI Number | 1174186134
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Entity Type | Individual
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Provider Name | JENNIFER MICHELLE VILLAFUERTE CMT
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Gender | Female
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Dates
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Enumeration Date | 04/16/2019
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Last Update Date | 12/31/2024
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Provider Practice Location Address
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Address Line | 5319 SUNRISE BLVD
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City | FAIR OAKS
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State | CA
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Zip | 95628-3539
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Country | US
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Telephone | 916-965-3689
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Fax |
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Provider Business Mailing Address
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Address Line | 9794 UTICA CT
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City | SACRAMENTO
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State | CA
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Zip | 95827-2717
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Country | US
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Telephone | 916-410-6226
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 33179
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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