Healthcare Provider Details

I. General information

NPI: 1285763516
Provider Name (Legal Business Name): PATRICIA VILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 S KINNELOA AVE STE 200
PASADENA CA
91107-3853
US

IV. Provider business mailing address

3521 E 60TH PL
HUNTINGTON PARK CA
90255-3220
US

V. Phone/Fax

Practice location:
  • Phone: 626-844-3033
  • Fax: 626-796-2433
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: