Provider Demographics
NPI:1184508442
Name:VILLA, KEVIN
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:VILLA
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 1:30933 TIDEWATER DR
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-1731
Mailing Address - Country:US
Mailing Address - Phone:510-676-9258
Mailing Address - Fax:
Practice Address - Street 1:3340 WALNUT AVE STE 290
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2215
Practice Address - Country:US
Practice Address - Phone:510-213-8336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-31
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician