1083198782 NPI number — VANESSA VILLASENOR LICENSED MARRIAGE AND FAMILY THERAPIST INC

Table of content: (NPI 1083198782)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083198782 NPI number — VANESSA VILLASENOR LICENSED MARRIAGE AND FAMILY THERAPIST INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VANESSA VILLASENOR LICENSED MARRIAGE AND FAMILY THERAPIST INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083198782
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
591 CAMINO DE LA REINA STE 802
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92108-3110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-519-8002
Provider Business Mailing Address Fax Number:
619-684-3788

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
591 CAMINO DE LA REINA STE 802
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108-3110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-519-8002
Provider Business Practice Location Address Fax Number:
619-684-3788
Provider Enumeration Date:
09/18/2018

Additional Information

Authorized Official

Authorized Official Last Name:
VILLASENOR
Authorized Official First Name:
VANESSA
Authorized Official Middle Name:
DANIELLE
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
858-519-8002

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1073892956 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1578926192 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1669011599 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1922333665 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1093267361 . This is a "NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1699020644 . This is a "NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1821355280 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1548601685 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1942653332 . This is a "NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1245646009 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1265998322 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1285844456 . This is a "NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1356963326 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1639564396 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1699159764 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1093267361 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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