Healthcare Provider Details

I. General information

NPI: 1790607588
Provider Name (Legal Business Name): KAYLINN VILLELA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4712 E 2ND ST STE 260
LONG BEACH CA
90803-5309
US

IV. Provider business mailing address

629 PINE AVE APT 11
LONG BEACH CA
90802-1334
US

V. Phone/Fax

Practice location:
  • Phone: 562-681-0334
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: