Provider Demographics
NPI:1285448357
Name:VILLALVAZO, ABEL
Entity type:Individual
Prefix:
First Name:ABEL
Middle Name:
Last Name:VILLALVAZO
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 1:10910 RESEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-2804
Mailing Address - Country:US
Mailing Address - Phone:213-984-6045
Mailing Address - Fax:
Practice Address - Street 1:10910 RESEDA BLVD
Practice Address - Street 2:
Practice Address - City:PORTER RANCH
Practice Address - State:CA
Practice Address - Zip Code:91326-2804
Practice Address - Country:US
Practice Address - Phone:213-984-6045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89167225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist