Provider Demographics
NPI:1164718235
Name:VILLARRUEL, GEORGE (CP)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:VILLARRUEL
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 N CHRISMAN RD
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95304-9314
Mailing Address - Country:US
Mailing Address - Phone:800-726-9180
Mailing Address - Fax:209-834-1158
Practice Address - Street 1:3001 L ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5225
Practice Address - Country:US
Practice Address - Phone:916-706-1520
Practice Address - Fax:916-706-1551
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter