Healthcare Provider Details

I. General information

NPI: 1518324805
Provider Name (Legal Business Name): CHRISTINA VILLASENOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2016
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 S BEAUDRY AVE
LOS ANGELES CA
90017-1466
US

IV. Provider business mailing address

16348 MARILYN DR
GRANADA HILLS CA
91344-3039
US

V. Phone/Fax

Practice location:
  • Phone: 213-241-1000
  • Fax:
Mailing address:
  • Phone: 818-390-0063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number15790
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: