Provider Demographics
NPI:1063274314
Name:VILLARRUEL, MARIVEL
Entity type:Individual
Prefix:
First Name:MARIVEL
Middle Name:
Last Name:VILLARRUEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1188 VISTA MONTANA
Mailing Address - Street 2:
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92582-4264
Mailing Address - Country:US
Mailing Address - Phone:951-206-3863
Mailing Address - Fax:
Practice Address - Street 1:1188 VISTA MONTANA
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92582-4264
Practice Address - Country:US
Practice Address - Phone:951-206-3863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker