Healthcare Provider Details

I. General information

NPI: 1376287334
Provider Name (Legal Business Name): LELAH SHARRA VILLALPANDO PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 12/28/2025
Certification Date: 12/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11354 MOUNTAIN VIEW AVE STE A
LOMA LINDA CA
92354-3855
US

IV. Provider business mailing address

11354 MOUNTAIN VIEW AVE STE A
LOMA LINDA CA
92354-3855
US

V. Phone/Fax

Practice location:
  • Phone: 909-665-4654
  • Fax: 888-414-1729
Mailing address:
  • Phone: 909-665-4654
  • Fax: 888-414-1729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY34387
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: