Provider Demographics
NPI:1922690239
Name:VILLARRUEL-PONCE, GENARO
Entity Type:Individual
Prefix:
First Name:GENARO
Middle Name:
Last Name:VILLARRUEL-PONCE
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 1:240 BOOTH ST APT L
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-1311
Mailing Address - Country:US
Mailing Address - Phone:775-996-3890
Mailing Address - Fax:
Practice Address - Street 1:300 LOS ALTOS PKWY STE 109
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-7754
Practice Address - Country:US
Practice Address - Phone:775-996-3890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician