MEDICARE: MR. CLIBERN DIZON VILLAFLOR MSN, PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	95039374	CA

General Provider Information

NPI Number	:	1831029206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CLIBERN DIZON VILLAFLOR MSN, PMHNP-BC

Provider Business Mailing Address
First Line	:	10808 FOOTHILL BLVD STE 160-419
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91730-3889
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	18800 AMAR RD STE B16
Second Line	:
City	:	WALNUT
State	:	CA
Zip	:	91789-7101
Country	:	US
Telephone Number	:	626-332-0311
Fax Number	:

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

Provider Enumeration Date	:	05/19/2026
Last Update Date	:	05/19/2026

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