Provider Demographics
NPI:1780365288
Name:VILLASENOR, LUIS
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:VILLASENOR
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 1:1845 JUNTURA CT S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-2348
Mailing Address - Country:US
Mailing Address - Phone:503-983-1192
Mailing Address - Fax:
Practice Address - Street 1:425 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-2482
Practice Address - Country:US
Practice Address - Phone:503-751-3048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach