Healthcare Provider Details

I. General information

NPI: 1538538368
Provider Name (Legal Business Name): MS. ALICIA VILLAPUDUA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2015
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 E PACIFIC COAST HWY STE 100
LONG BEACH CA
90804
US

IV. Provider business mailing address

123 S ALVARADO ST
LOS ANGELES CA
90057-2201
US

V. Phone/Fax

Practice location:
  • Phone: 562-490-7600
  • Fax: 562-490-7601
Mailing address:
  • Phone: 121-398-9770
  • Fax: 213-989-7702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number83628
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License NumberMFTI 83626
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: