Basic Information
| Provider Information | |||||||||
| NPI: | 1538749171 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VILLANUEVA | ||||||||
| FirstName: | EMELI | ||||||||
| MiddleName: | SIOMARA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 906 N RIDGEWOOD PL | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900383206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3238986067 | ||||||||
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| Practice Location | |||||||||
| Address1: | 566 S BRAND BLVD | ||||||||
| Address2: | |||||||||
| City: | SAN FERNANDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913404002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188980223 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2021 | ||||||||
| LastUpdateDate: | 05/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 132762 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.