Provider Demographics
NPI:1275032773
Name:VILLATORO, BREANNA ALEXA (BA)
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:ALEXA
Last Name:VILLATORO
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:BREANNA
Other - Middle Name:ALEXA
Other - Last Name:VILLATORO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:P.O. BOX 1000
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93302
Mailing Address - Country:US
Mailing Address - Phone:661-868-6840
Mailing Address - Fax:
Practice Address - Street 1:2621 OSWELL ST.
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306
Practice Address - Country:US
Practice Address - Phone:661-868-6956
Practice Address - Fax:866-331-4283
Is Sole Proprietor?:No
Enumeration Date:2018-02-09
Last Update Date:2024-02-13
Deactivation Date:2021-09-27
Deactivation Code:
Reactivation Date:2021-10-18
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker