MEDICARE: DENISE VILLEGAS

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	106S00000X	Behavior Technician		CA

General Provider Information

NPI Number	:	1720871932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE VILLEGAS

Provider Business Mailing Address
First Line	:	119 W TORRANCE BLVD STE 100
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-3600
Country	:	US
Telephone Number	:	310-374-3300
Fax Number	:	310-374-3307

Provider Business Practice Location Address
First Line	:	3045 S ARCHIBALD AVE STE H-1043
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91761-9001
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:

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

Provider Enumeration Date	:	05/28/2025
Last Update Date	:	03/05/2026

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Directions to “ DENISE VILLEGAS ” Practice Location

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