Healthcare Provider Details

I. General information

NPI: 1649056441
Provider Name (Legal Business Name): ANTHONY VILLA PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2023
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 E 4TH ST STE 156
SANTA ANA CA
92701-5170
US

IV. Provider business mailing address

300 S DOHENY DR # 215
LOS ANGELES CA
90048-3704
US

V. Phone/Fax

Practice location:
  • Phone: 949-415-4443
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35606
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: