Provider Demographics
NPI:1043708787
Name:SEVILLO, VIRGINIA ANN
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:ANN
Last Name:SEVILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 FAIRHAVEN ST
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93905-2411
Mailing Address - Country:US
Mailing Address - Phone:831-594-2475
Mailing Address - Fax:
Practice Address - Street 1:165 CLAY ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-2509
Practice Address - Country:US
Practice Address - Phone:831-422-6226
Practice Address - Fax:831-422-6296
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty