Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor |
NPI | 1003336280 |
---|---|
Provider Name | Angelica Marie Lemelle Villalobos |
First Address | Sacramento, CA 95817-1353 |
Second Address | Sacramento, CA 95817-1353 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2017 |
Last Update Date | 24/10/2019 |