Healthcare Provider Details

I. General information

NPI: 1003387259
Provider Name (Legal Business Name): VILLA ESPERANZA SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 12/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2088 E VILLA ST
PASADENA CA
91107-2433
US

IV. Provider business mailing address

2116 E VILLA ST
PASADENA CA
91107-2435
US

V. Phone/Fax

Practice location:
  • Phone: 626-449-2919
  • Fax: 626-449-2850
Mailing address:
  • Phone: 626-449-2919
  • Fax: 626-449-2850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAMION LEE
Title or Position: DIRECTOR
Credential:
Phone: 626-449-2919