Healthcare Provider Details

I. General information

NPI: 1043748437
Provider Name (Legal Business Name): MRS. JULIA FAY VILLARREAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. JULIA FAY LIM-VILLARREAL

II. Dates (important events)

Enumeration Date: 05/30/2017
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date: 05/15/2018
Reactivation Date: 05/21/2018

III. Provider practice location address

4470 W SUNSET BLVD STE 107
LOS ANGELES CA
90027-6309
US

IV. Provider business mailing address

7273 14TH AVE #120B
SACRAMENTO CA
95820
US

V. Phone/Fax

Practice location:
  • Phone: 916-919-7070
  • Fax:
Mailing address:
  • Phone: 210-739-3247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number107363
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: