Healthcare Provider Details

I. General information

NPI: 1548758592
Provider Name (Legal Business Name): KAREN ALEXANDRA VILLEGAS MSC, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2018
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11650 IBERIA PL STE 130
SAN DIEGO CA
92128-2431
US

IV. Provider business mailing address

550 OXFORD ST APT 212
CHULA VISTA CA
91911-2702
US

V. Phone/Fax

Practice location:
  • Phone: 858-264-5858
  • Fax:
Mailing address:
  • Phone: 619-392-9066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBCBA-1-20-43984
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-17-46138
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: