Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TR0400X | Rehabilitation Psychologist | ||
Y | 225XE0001X | Environmental Modification |
NPI | 1598424160 |
---|---|
Provider Name | Mr. Gonzalo Villegas |
First Address | Sahuarita, AZ 85629-8205 |
Second Address | Sahuarita, AZ 85629-8205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2021 |
Last Update Date | 10/12/2021 |