Healthcare Provider Details

I. General information

NPI: 1538022355
Provider Name (Legal Business Name): VIRIDIANA VILLEGAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6625 LA PALMA AVE
BUENA PARK CA
90620-2859
US

IV. Provider business mailing address

6625 LA PALMA AVE
BUENA PARK CA
90620-2859
US

V. Phone/Fax

Practice location:
  • Phone: 714-293-3584
  • Fax:
Mailing address:
  • Phone: 714-293-3584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberASW116816
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: