Healthcare Provider Details

I. General information

NPI: 1720487234
Provider Name (Legal Business Name): CINDY VILLAVERDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2014
Last Update Date: 03/08/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17707 STUDEBAKER RD
CERRITOS CA
90703-2640
US

IV. Provider business mailing address

PO BOX 12312
ORANGE CA
92859-8312
US

V. Phone/Fax

Practice location:
  • Phone: 562-402-0688
  • Fax:
Mailing address:
  • Phone: 714-499-3941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number90332
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number90332
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: