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General NPI Number Information
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NPI Number | 1184508442
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Entity Type | Individual
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Provider Name | KEVIN VILLA
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Gender | Male
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Dates
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Enumeration Date | 07/31/2025
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 3340 WALNUT AVE STE 290
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City | FREMONT
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State | CA
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Zip | 94538-2215
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Country | US
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Telephone | 510-213-8336
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Fax |
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Provider Business Mailing Address
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Address Line | 30933 TIDEWATER DR
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City | UNION CITY
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State | CA
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Zip | 94587-1731
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Country | US
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Telephone | 510-676-9258
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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