1962528950 NPI number — MRS. DIANA MARIA VILLALOBOS AMFTI - ASSOCIATE MA

Table of content: MRS. DIANA MARIA VILLALOBOS AMFTI - ASSOCIATE MA (NPI 1962528950)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962528950 NPI number — MRS. DIANA MARIA VILLALOBOS AMFTI - ASSOCIATE MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VILLALOBOS
Provider First Name:
DIANA
Provider Middle Name:
MARIA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
AMFTI - ASSOCIATE MA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1962528950
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/29/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1250 CENTRAL AVE
Provider Second Line Business Mailing Address:
S1
Provider Business Mailing Address City Name:
WENATCHEE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-253-0836
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 EASTMONT AVE CHILDRENS HOME SOCIETY OF WASHINGTON
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
EAST WENATCHEE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-885-9090
Provider Business Practice Location Address Fax Number:
509-884-0118
Provider Enumeration Date:
03/21/2007

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: 101YM0800X , with the licence number:  68791 , 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)





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