Provider Demographics
NPI:1710508437
Name:VILLARREAL, ALLEN MATTHEW
Entity Type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:MATTHEW
Last Name:VILLARREAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 N DEMAREE ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-7703
Mailing Address - Country:US
Mailing Address - Phone:559-429-3267
Mailing Address - Fax:559-732-1797
Practice Address - Street 1:1320 N DEMAREE ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-7703
Practice Address - Country:US
Practice Address - Phone:559-429-3267
Practice Address - Fax:559-732-1797
Is Sole Proprietor?:No
Enumeration Date:2020-05-04
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10051374183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician