Basic Information
| Provider Information | |||||||||
| NPI: | 1760094734 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VILLEGAS | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | DE JESUS | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MOBILE ASSESSMENT CO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 406 | ||||||||
| Address2: | |||||||||
| City: | PAUMA VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920610406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607491410 | ||||||||
| FaxNumber: | 7607495518 | ||||||||
| Practice Location | |||||||||
| Address1: | 1105 BROADWAY STE 207 | ||||||||
| Address2: | |||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919112767 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194255609 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2020 | ||||||||
| LastUpdateDate: | 07/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 174H00000X | N | Other Service Providers | Health Educator |
No ID Information.