Provider Demographics
NPI:1386206183
Name:VILLARREAL, PHILLIP ARTHUR (MA, SLP)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:ARTHUR
Last Name:VILLARREAL
Suffix:
Gender:M
Credentials:MA, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W 6TH ST STE I
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-6014
Mailing Address - Country:US
Mailing Address - Phone:408-847-7900
Mailing Address - Fax:408-847-3757
Practice Address - Street 1:700 W 6TH ST STE I
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-6014
Practice Address - Country:US
Practice Address - Phone:408-847-7900
Practice Address - Fax:408-847-3757
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPE13468235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist