Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003183278 |
---|---|
Provider Name | Evelyn Lucero Villareal |
First Address | Los Angeles, CA 90012-3208 |
Second Address | Los Angeles, CA 90012-3208 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2011 |
Last Update Date | 16/11/2011 |