MEDICARE: JACQUELINE MONIQUE VILLALVA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-26-90602	CA

General Provider Information

NPI Number	:	1003497413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE MONIQUE VILLALVA

Provider Business Mailing Address
First Line	:	445 MARINE VIEW AVE STE 206
Second Line	:
City	:	DEL MAR
State	:	CA
Zip	:	92014-3951
Country	:	US
Telephone Number	:	619-961-2015
Fax Number	:

Provider Business Practice Location Address
First Line	:	445 MARINE VIEW AVE STE 206
Second Line	:
City	:	DEL MAR
State	:	CA
Zip	:	92014-3951
Country	:	US
Telephone Number	:	619-961-2015
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2021
Last Update Date	:	06/14/2026

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