Healthcare Provider Details

I. General information

NPI: 1902311863
Provider Name (Legal Business Name): DONNA LYNN VILLANUEVA MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2017
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 HOSPITAL RD
SONORA CA
95370-4816
US

IV. Provider business mailing address

2 S. GREEN ST.
SONORA CA
95370-4816
US

V. Phone/Fax

Practice location:
  • Phone: 209-533-6245
  • Fax:
Mailing address:
  • Phone: 209-533-6245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number99690-LMFT
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: