Healthcare Provider Details

I. General information

NPI: 1003473943
Provider Name (Legal Business Name): JESSICA VILLAFRANCO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2019
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11370 ANDERSON ST
LOMA LINDA CA
92354-3450
US

IV. Provider business mailing address

PO BOX 7294
REDLANDS CA
92375-0294
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-5978
  • Fax:
Mailing address:
  • Phone: 213-610-2388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number106604
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: