MEDICARE: PAULINA CONSTANZA VILLALON SLP

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	235Z00000X	Speech-Language Pathologist	40355	CA

General Provider Information

NPI Number	:	1902739238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULINA CONSTANZA VILLALON SLP

Provider Business Mailing Address
First Line	:	1401 BROADWAY AVE
Second Line	:
City	:	ATWATER
State	:	CA
Zip	:	95301-3546
Country	:	US
Telephone Number	:	209-357-6100
Fax Number	:

Provider Business Practice Location Address
First Line	:	1753 5TH ST
Second Line	:
City	:	ATWATER
State	:	CA
Zip	:	95301-3620
Country	:	US
Telephone Number	:	209-357-6506
Fax Number	:

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

Provider Enumeration Date	:	06/05/2026
Last Update Date	:	06/05/2026

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Directions to “ PAULINA CONSTANZA VILLALON SLP” Practice Location

Language	Start Address	Practice Location

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