Healthcare Provider Details

I. General information

NPI: 1730448267
Provider Name (Legal Business Name): VICKY VILLALOBOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2012
Last Update Date: 07/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3208 ROSEMEAD BLVD STE 100
EL MONTE CA
91731-2830
US

IV. Provider business mailing address

PO BOX 39632
DOWNEY CA
90239-0632
US

V. Phone/Fax

Practice location:
  • Phone: 626-227-7001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: