Basic Information
| Provider Information | |||||||||
| NPI: | 1114419082 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VILLAREAL RODRIGUEZ | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | ANGEL | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5201 S VERMONT AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900373527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3237513026 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5425 POMONA BLVD | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900221716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3237280411 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2018 | ||||||||
| LastUpdateDate: | 03/19/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | ASW67403 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 104100000X | ASW67403 | CA | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.