1831228824 NPI number — MR. JOSE ELIAS VILLAFANA MFT

Table of content: MR. JOSE ELIAS VILLAFANA MFT (NPI 1831228824)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831228824 NPI number — MR. JOSE ELIAS VILLAFANA MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VILLAFANA
Provider First Name:
JOSE
Provider Middle Name:
ELIAS
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MFT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VILLAFANA
Provider Other First Name:
ELIAS
Provider Other Middle Name:
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MFT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1831228824
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1156
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEMON GROVE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91946-1156
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-540-0700
Provider Business Mailing Address Fax Number:
619-462-1856

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8080 LA MESA BLVD STE 204
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91942-0362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-540-0700
Provider Business Practice Location Address Fax Number:
619-462-1856
Provider Enumeration Date:
03/05/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC 36841 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)