Provider Demographics
NPI:1700597887
Name:VILLARREAL, ROBERTO JR (RADT-I)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:VILLARREAL
Suffix:JR
Gender:M
Credentials:RADT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 22ND ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-3503
Mailing Address - Country:US
Mailing Address - Phone:916-442-3979
Mailing Address - Fax:
Practice Address - Street 1:2218 E ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-3511
Practice Address - Country:US
Practice Address - Phone:916-442-4519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)