Basic Information
| Provider Information | |||||||||
| NPI: | 1568777241 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VILLASENOR | ||||||||
| FirstName: | MONIQUE | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.S. IMF | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1105 BROADWAY | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919112767 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194255609 | ||||||||
| FaxNumber: | 6194258349 | ||||||||
| Practice Location | |||||||||
| Address1: | 7545 METROPOLITAN DR | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921084402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6197189890 | ||||||||
| FaxNumber: | 6197189897 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2010 | ||||||||
| LastUpdateDate: | 11/21/2019 | ||||||||
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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 | 101YA0400X | AII5021314 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.