Healthcare Provider Details

I. General information

NPI: 1114872868
Provider Name (Legal Business Name): ANGEL VILLAGOMEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 S SAN PEDRO ST
LOS ANGELES CA
90013-1633
US

IV. Provider business mailing address

345 S SAN PEDRO ST
LOS ANGELES CA
90013-1633
US

V. Phone/Fax

Practice location:
  • Phone: 213-537-0822
  • Fax:
Mailing address:
  • Phone: 213-537-0822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT164880
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: