Healthcare Provider Details

I. General information

NPI: 1992266837
Provider Name (Legal Business Name): COLEEN VILLEGAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 03/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 W ADAMS BLVD STE 314
LOS ANGELES CA
90018-3515
US

IV. Provider business mailing address

2108 NIPOMO AVE
LONG BEACH CA
90815-3523
US

V. Phone/Fax

Practice location:
  • Phone: 310-553-2695
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: