MEDICARE: MARY GRACE N VILLAR-RAKES

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	106E00000X	Assistant Behavior Analyst

General Provider Information

NPI Number	:	1861159808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY GRACE N VILLAR-RAKES

Provider Business Mailing Address
First Line	:	2730 SHADELANDS DR BLDG 10
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94598-2538
Country	:	US
Telephone Number	:	925-266-8400
Fax Number	:

Provider Business Practice Location Address
First Line	:	744 EMPIRE ST STE 160
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-5562
Country	:	US
Telephone Number	:	707-399-9413
Fax Number	:

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

Provider Enumeration Date	:	11/24/2021
Last Update Date	:	06/23/2026

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