Provider Demographics
NPI:1851517023
Name:VILLARREAL, KATHRYN LOREE (PA)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:LOREE
Last Name:VILLARREAL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7014 N WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-0155
Mailing Address - Country:US
Mailing Address - Phone:559-321-2800
Mailing Address - Fax:559-321-2780
Practice Address - Street 1:7014 N WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-0155
Practice Address - Country:US
Practice Address - Phone:559-321-2800
Practice Address - Fax:559-321-2780
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18758363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00794487OtherRAILROAD MEDICARE
CAWPA18758AMedicare PIN