Provider Demographics
NPI:1063820835
Name:VILLAFANA, SANDRA (LM, CPM)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:VILLAFANA
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:MRS
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:MCLAY VILLAFANA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LM, CPM
Mailing Address - Street 1:2505 TRAIL MARKER PL
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-4160
Mailing Address - Country:US
Mailing Address - Phone:619-778-2435
Mailing Address - Fax:
Practice Address - Street 1:2505 TRAIL MARKER PL
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-4160
Practice Address - Country:US
Practice Address - Phone:619-778-2435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM 314176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife