Healthcare Provider Details

I. General information

NPI: 1003795436
Provider Name (Legal Business Name): MICHELLE VILLALTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2025
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

849 E 6TH ST
LOS ANGELES CA
90021-1026
US

IV. Provider business mailing address

849 E 6TH ST
LOS ANGELES CA
90021-1026
US

V. Phone/Fax

Practice location:
  • Phone: 213-623-8446
  • Fax:
Mailing address:
  • Phone: 213-623-8446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: