Basic Information
| Provider Information | |||||||||
| NPI: | 1003197161 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VILLEDA | ||||||||
| FirstName: | ESMERALDA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MISS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3215 LILLIS AVE | ||||||||
| Address2: | |||||||||
| City: | N LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890306680 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027169596 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3435 W CRAIG RD | ||||||||
| Address2: | |||||||||
| City: | N LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890325115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027500377 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2011 | ||||||||
| LastUpdateDate: | 09/02/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.