Individual
WILLY VILLAGRAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
21229 HAWTHORNE BLVD STE A, TORRANCE, CA 90503-5501
(310) 409-4265
Mailing address
308 S BUSH ST, ANAHEIM, CA 92805-4129
(714) 232-6769
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
72577
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
72577
—
CA
Enumeration date
03/31/2016
Last updated
10/05/2020
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