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General NPI Number Information
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NPI Number | 1831228824
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Entity Type | Individual
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Provider Name | JOSE ELIAS VILLAFANA MFT
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Gender | Male
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 8080 LA MESA BLVD STE 204
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City | LA MESA
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State | CA
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Zip | 91942-0362
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Country | US
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Telephone | 619-540-0700
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Fax | 619-462-1856
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Provider Business Mailing Address
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Address Line | PO BOX 1156
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City | LEMON GROVE
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State | CA
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Zip | 91946-1156
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Country | US
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Telephone | 619-540-0700
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Fax | 619-462-1856
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC 36841
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License Number State | CA
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