Provider Demographics
NPI:1801774351
Name:GARCIA VILLALPANDO, MIGUEL ANGEL (DPT)
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:ANGEL
Last Name:GARCIA VILLALPANDO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2826 FULTON RD
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:CA
Mailing Address - Zip Code:95439-8803
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3975 OLD REDWOOD HWY STE 152
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1719
Practice Address - Country:US
Practice Address - Phone:707-566-5857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-23
Last Update Date:2025-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA308758225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist