Provider Demographics
NPI:1043868946
Name:VILLALPANDO, MATHEW BRIAN
Entity type:Individual
Prefix:
First Name:MATHEW
Middle Name:BRIAN
Last Name:VILLALPANDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 S PROSPERO DR
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-4965
Mailing Address - Country:US
Mailing Address - Phone:626-394-1006
Mailing Address - Fax:
Practice Address - Street 1:677 CLIFFSIDE DR STE 677
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-2957
Practice Address - Country:US
Practice Address - Phone:909-971-4140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY3258355103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst