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NPI Code Detail

MEDICARE: VANESSA J VILLAGOMEZ

MEDICARE: VANESSA J VILLAGOMEZ
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1770255036
Entity Type Code : Individual
Provider Name (Legal Business Name) : VANESSA J VILLAGOMEZ
Provider Business Mailing Address
First Line : PO BOX 53413
Second Line :
City : IRVINE
State : CA
Zip : 92619-3413
Country : US
Telephone Number : 951-228-2832
Fax Number : 714-333-4535
Provider Business Practice Location Address
First Line : 6529 RIVERSIDE AVE STE 250
Second Line :
City : RIVERSIDE
State : CA
Zip : 92506-3126
Country : US
Telephone Number : 951-228-2832
Fax Number : 714-333-4535
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2021
Last Update Date : 10/04/2021

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Directions to “ VANESSA J VILLAGOMEZ ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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