Provider Demographics
NPI:1922113596
Name:VILLEGAS, ROLDAN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:ROLDAN
Middle Name:
Last Name:VILLEGAS
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4007 ROYAL VISTA CIR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-4707
Mailing Address - Country:US
Mailing Address - Phone:951-371-7160
Mailing Address - Fax:951-371-7160
Practice Address - Street 1:4007 ROYAL VISTA CIR
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-4707
Practice Address - Country:US
Practice Address - Phone:951-808-9957
Practice Address - Fax:951-808-9957
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 26046225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist