Healthcare Provider Details

I. General information

NPI: 1508478769
Provider Name (Legal Business Name): SUSANA ELIZABETH VILLALPANDO MA, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15611 POMERADO RD STE 535
POWAY CA
92064-2413
US

IV. Provider business mailing address

15611 POMERADO RD STE 535
POWAY CA
92064-2413
US

V. Phone/Fax

Practice location:
  • Phone: 858-279-1223
  • Fax:
Mailing address:
  • Phone: 858-279-1223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number155968
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: