Provider Demographics
NPI:1427754050
Name:VILLAGRAN, BYRON ALFREDO (COTA)
Entity type:Individual
Prefix:
First Name:BYRON
Middle Name:ALFREDO
Last Name:VILLAGRAN
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:BYRON
Other - Middle Name:ALFREDO
Other - Last Name:VILLAGRAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA
Mailing Address - Street 1:61 ALIENTO
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-1128
Mailing Address - Country:US
Mailing Address - Phone:951-973-2897
Mailing Address - Fax:
Practice Address - Street 1:24452 HEALTH CENTER DR
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3604
Practice Address - Country:US
Practice Address - Phone:949-837-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5927224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant