Provider Demographics
NPI:1598424160
Name:VILLEGAS, GONZALO
Entity Type:Individual
Prefix:MR
First Name:GONZALO
Middle Name:
Last Name:VILLEGAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:GONZALO
Other - Middle Name:
Other - Last Name:VILLEGAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:962 W CALLE VALENCIANA
Mailing Address - Street 2:
Mailing Address - City:SAHUARITA
Mailing Address - State:AZ
Mailing Address - Zip Code:85629-8205
Mailing Address - Country:US
Mailing Address - Phone:520-328-4463
Mailing Address - Fax:
Practice Address - Street 1:962 W CALLE VALENCIANA
Practice Address - Street 2:
Practice Address - City:SAHUARITA
Practice Address - State:AZ
Practice Address - Zip Code:85629-8205
Practice Address - Country:US
Practice Address - Phone:520-328-4463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistEnvironmental Modification
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation