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Individual

IVAN VILLANEDA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
ATC

Contact information

Practice address
79 NEW MONTGOMERY ST, SAN FRANCISCO, CA 94105-3410
(909) 295-1320
Mailing address
16135 HARVEST MOON ST, LA PUENTE, CA 91744-1337
(909) 295-1320

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary

Other

Enumeration date
05/18/2017
Last updated
05/18/2017
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