Healthcare Provider Details

I. General information

NPI: 1770168510
Provider Name (Legal Business Name): ELIZABETH GUADALUPE VILLA AA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2021
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18031 US HIGHWAY 18
APPLE VALLEY CA
92307-2152
US

IV. Provider business mailing address

18031 US HIGHWAY 18
APPLE VALLEY CA
92307-2152
US

V. Phone/Fax

Practice location:
  • Phone: 760-282-4385
  • Fax:
Mailing address:
  • Phone: 760-282-4385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number163850
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: