Healthcare Provider Details

I. General information

NPI: 1265199319
Provider Name (Legal Business Name): SYRENA SKYE VILLAREAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7735 LEEDS ST
DOWNEY CA
90242-3489
US

IV. Provider business mailing address

7735 LEEDS ST
DOWNEY CA
90242-3489
US

V. Phone/Fax

Practice location:
  • Phone: 562-719-2865
  • Fax:
Mailing address:
  • Phone: 562-719-2865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number42897
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: