Healthcare Provider Details

I. General information

NPI: 1114419082
Provider Name (Legal Business Name): STEVEN ANGEL VILLAREAL RODRIGUEZ MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5425 POMONA BLVD
LOS ANGELES CA
90022-1716
US

IV. Provider business mailing address

5201 S VERMONT AVE
LOS ANGELES CA
90037-3527
US

V. Phone/Fax

Practice location:
  • Phone: 323-728-0411
  • Fax:
Mailing address:
  • Phone: 323-751-3026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW67403
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW67403
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: