Healthcare Provider Details

I. General information

NPI: 1669053872
Provider Name (Legal Business Name): PAULINA ELIZABETH VILLAGOMEZ ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2021
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9246 LIGHTWAVE AVE STE 120
SAN DIEGO CA
92123-6411
US

IV. Provider business mailing address

9246 LIGHTWAVE AVE STE 120
SAN DIEGO CA
92123-6411
US

V. Phone/Fax

Practice location:
  • Phone: 800-270-5016
  • Fax: 800-680-3626
Mailing address:
  • Phone: 800-270-5016
  • Fax: 800-680-3626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberACSW139232
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: