Healthcare Provider Details

I. General information

NPI: 1558276758
Provider Name (Legal Business Name): JENNIFER GODINEZ VILLICANA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER DOMINGUEZ VILLICANA

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 W WASHINGTON AVE APT 411
ESCONDIDO CA
92025-2651
US

IV. Provider business mailing address

439 W WASHINGTON AVE APT 411
ESCONDIDO CA
92025-2651
US

V. Phone/Fax

Practice location:
  • Phone: 760-704-3507
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: