Healthcare Provider Details

I. General information

NPI: 1851636583
Provider Name (Legal Business Name): MAYRA A. VILLARREAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2012
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5628 E SLAUSON AVE
COMMERCE CA
90040-2922
US

IV. Provider business mailing address

5628 E SLAUSON AVE
COMMERCE CA
90040-2922
US

V. Phone/Fax

Practice location:
  • Phone: 323-318-9960
  • Fax: 323-780-3211
Mailing address:
  • Phone: 323-318-9960
  • Fax: 323-780-3211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: