Healthcare Provider Details

I. General information

NPI: 1902457419
Provider Name (Legal Business Name): LAURA ANGELICA VILLASENOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2019
Last Update Date: 02/13/2021
Certification Date: 01/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 PAJARO ST STE B
SALINAS CA
93901-3400
US

IV. Provider business mailing address

150 CAYUGA ST STE 3
SALINAS CA
93901-2684
US

V. Phone/Fax

Practice location:
  • Phone: 831-649-4522
  • Fax:
Mailing address:
  • Phone: 831-975-5845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: