Provider Demographics
NPI:1043900046
Name:VILLANUEVA, RUBEN III
Entity type:Individual
Prefix:
First Name:RUBEN
Middle Name:
Last Name:VILLANUEVA
Suffix:III
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 1:31869 FLORIDA ST
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-7552
Mailing Address - Country:US
Mailing Address - Phone:909-838-4824
Mailing Address - Fax:
Practice Address - Street 1:31869 FLORIDA ST
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-7552
Practice Address - Country:US
Practice Address - Phone:909-838-4824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician