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General NPI Number Information
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NPI Number | 1881739902
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Entity Type | Individual
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Provider Name | SAMANTHA VILLALOBOS
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Gender | Female
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 08/05/2014
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Provider Practice Location Address
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Address Line | 760 E BRIER DR
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-2827
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Country | US
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Telephone | 909-386-9572
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Fax |
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Provider Business Mailing Address
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Address Line | 538 E BONNIE BRAE CT
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City | ONTARIO
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State | CA
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Zip | 91764-1803
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Country | US
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Telephone | 909-223-9959
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Fax |
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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 | 73406
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License Number State | CA
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