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General NPI Number Information
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NPI Number | 1366974818
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Entity Type | Individual
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Provider Name | ALEJANDRA VILLAGOMEZ
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Gender | Female
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Dates
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Enumeration Date | 04/03/2017
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 324 ROXBURY RD
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City | ROCKFORD
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State | IL
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Zip | 61107-5090
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Country | US
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Telephone | 815-398-9491
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Fax | 815-381-7498
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Provider Business Mailing Address
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Address Line | PO BOX 735263
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City | CHICAGO
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State | IL
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Zip | 60673-5263
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Country | US
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Telephone | 815-398-9491
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Fax | 815-381-7498
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | V42500096844
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 056016655
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License Number State | IL
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