Provider Demographics
NPI:1164853180
Name:VILLALVA, LETICIA
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:VILLALVA
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 1:377 E CHAPMAN AVE
Mailing Address - Street 2:STE. 110
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-5055
Mailing Address - Country:US
Mailing Address - Phone:714-577-5400
Mailing Address - Fax:714-577-5450
Practice Address - Street 1:377 E CHAPMAN AVE
Practice Address - Street 2:STE. 110
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-5055
Practice Address - Country:US
Practice Address - Phone:714-577-5400
Practice Address - Fax:714-577-5450
Is Sole Proprietor?:No
Enumeration Date:2013-12-01
Last Update Date:2013-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist