Provider Demographics
NPI:1730976028
Name:VILLARREAL, IDDOLINA JAILENE
Entity type:Individual
Prefix:
First Name:IDDOLINA
Middle Name:JAILENE
Last Name:VILLARREAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6255 W TROPICANA AVE APT 251
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-4647
Mailing Address - Country:US
Mailing Address - Phone:702-416-6589
Mailing Address - Fax:
Practice Address - Street 1:6325 S JONES BLVD STE 400
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-3332
Practice Address - Country:US
Practice Address - Phone:702-618-9120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT-25-415833106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician