MEDICARE: KAREN VILLANUEVA-BERNAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	0803875361	NV

General Provider Information

NPI Number	:	1669008165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN VILLANUEVA-BERNAL

Provider Business Mailing Address
First Line	:	2151 PROFESSIONAL DR STE 100
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-3761
Country	:	US
Telephone Number	:	916-771-0520
Fax Number	:

Provider Business Practice Location Address
First Line	:	5470 KIETZKE LN
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89511-3023
Country	:	US
Telephone Number	:	775-393-3029
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2020
Last Update Date	:	03/16/2020

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