MEDICARE: MS. MAIRA MARYSOL VILLEGAS MS

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
1	101YP2500X	Professional Counselor	15456	CA

General Provider Information

NPI Number	:	1922878073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MAIRA MARYSOL VILLEGAS MS

Provider Business Mailing Address
First Line	:	7673 KILARNEY LN APT 103
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95610-2972
Country	:	US
Telephone Number	:	916-899-1965
Fax Number	:

Provider Business Practice Location Address
First Line	:	7673 KILARNEY LN APT 103
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95610-2972
Country	:	US
Telephone Number	:	916-899-1965
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2024
Last Update Date	:	01/08/2024

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