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NPI Code Detail

MEDICARE: PAULETTE REGINA VILLA

MEDICARE: PAULETTE REGINA VILLA
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1134621998
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAULETTE REGINA VILLA
Provider Business Mailing Address
First Line : 1835 ALLSTON WAY
Second Line :
City : BERKELEY
State : CA
Zip : 94703-1764
Country : US
Telephone Number : 510-666-9552
Fax Number :
Provider Business Practice Location Address
First Line : 1835 ALLSTON WAY
Second Line :
City : BERKELEY
State : CA
Zip : 94703-1764
Country : US
Telephone Number : 510-666-9552
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2018
Last Update Date : 03/07/2018

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Directions to “ PAULETTE REGINA VILLA ” Practice Location

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