Provider Demographics
NPI:1528715687
Name:VILLARREAL, VERONICA
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:VILLARREAL
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 1:1508 S 430 W
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-7325
Mailing Address - Country:US
Mailing Address - Phone:385-206-7475
Mailing Address - Fax:
Practice Address - Street 1:24 W SERGEANT COURT DR STE 204
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:UT
Practice Address - Zip Code:84045-5809
Practice Address - Country:US
Practice Address - Phone:208-252-4028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician