MEDICARE: VANESSA VILLA AMFT 127635

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	106H00000X	Marriage & Family Therapist	127635	CA

General Provider Information

NPI Number	:	1174985782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA VILLA AMFT 127635

Provider Business Mailing Address
First Line	:	900 CORPORATE CENTER DR STE 350
Second Line	:
City	:	MONTEREY PARK
State	:	CA
Zip	:	91754-7620
Country	:	US
Telephone Number	:	323-526-4016
Fax Number	:	323-526-4096

Provider Business Practice Location Address
First Line	:	2958 E FLORENCE AVE FL 2
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-5826
Country	:	US
Telephone Number	:	323-923-9559
Fax Number	:	323-923-9566

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

Provider Enumeration Date	:	03/23/2016
Last Update Date	:	08/28/2024

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