Healthcare Provider Details

I. General information

NPI: 1588011001
Provider Name (Legal Business Name): STEPHANIE YVETTE VILLA R1231900616
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2016
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 TRUXTUN AVE STE 200
BAKERSFIELD CA
93301-3143
US

IV. Provider business mailing address

3300 TRUXTUN AVE STE 200
BAKERSFIELD CA
93301-3143
US

V. Phone/Fax

Practice location:
  • Phone: 661-868-8300
  • Fax: 661-868-8317
Mailing address:
  • Phone: 661-868-8300
  • Fax: 661-326-1342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1231900616
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberA051290819
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberA051290819
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: