Provider Demographics
NPI:1861680787
Name:VILLAFUERTE, TEMUGEN YBASCO
Entity Type:Individual
Prefix:
First Name:TEMUGEN
Middle Name:YBASCO
Last Name:VILLAFUERTE
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 1:100 S ELLSWORTH AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3932
Mailing Address - Country:US
Mailing Address - Phone:650-343-4504
Mailing Address - Fax:
Practice Address - Street 1:100 S ELLSWORTH AVE STE 203
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3932
Practice Address - Country:US
Practice Address - Phone:650-343-4504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter