Healthcare Provider Details

I. General information

NPI: 1700780079
Provider Name (Legal Business Name): ANNELISE YVETTE VILCHEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 HILLSIDE ST APT 26
LA HABRA CA
90631-2860
US

IV. Provider business mailing address

921 HILLSIDE ST APT 26
LA HABRA CA
90631-2860
US

V. Phone/Fax

Practice location:
  • Phone: 562-844-8678
  • Fax: 562-844-8678
Mailing address:
  • Phone: 562-844-8678
  • Fax: 562-844-8678

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: