Healthcare Provider Details

I. General information

NPI: 1255248878
Provider Name (Legal Business Name): CYNTHIA M VILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

1544 E COLLINS AVE
ORANGE CA
92867-5934
US

IV. Provider business mailing address

390 S PINE ST
ORANGE CA
92866-2060
US

V. Phone/Fax

Practice location:
  • Phone: 714-631-6569
  • Fax:
Mailing address:
  • Phone: 714-631-6569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number103204
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: