Healthcare Provider Details

I. General information

NPI: 1982182499
Provider Name (Legal Business Name): MILAGROS JACQUELINE VILLARREAL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2018
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

393 E WALNUT ST
PASADENA CA
91188-0001
US

IV. Provider business mailing address

5585 LIME AVE
LONG BEACH CA
90805-5416
US

V. Phone/Fax

Practice location:
  • Phone: 183-357-4227
  • Fax:
Mailing address:
  • Phone: 310-531-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number101787
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: