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General NPI Number Information
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NPI Number | 1760094734
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Entity Type | Individual
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Provider Name | MARIA DE JESUS VILLEGAS MOBILE ASSESSMENT CO
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Gender | Female
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Dates
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Enumeration Date | 08/20/2020
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Last Update Date | 07/06/2022
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Provider Practice Location Address
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Address Line | 1105 BROADWAY STE 207
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City | CHULA VISTA
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State | CA
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Zip | 91911-2767
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Country | US
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Telephone | 619-425-5609
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 406
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City | PAUMA VALLEY
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State | CA
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Zip | 92061-0406
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Country | US
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Telephone | 760-749-1410
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Fax | 760-749-5518
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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