Provider Demographics
NPI:1205360609
Name:VILLAFANA, DOLORES
Entity Type:Individual
Prefix:MISS
First Name:DOLORES
Middle Name:
Last Name:VILLAFANA
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 1:5135 CAMINO AL NORTE STE 114
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-2390
Mailing Address - Country:US
Mailing Address - Phone:702-340-3160
Mailing Address - Fax:
Practice Address - Street 1:5135 CAMINO AL NORTE STE 114
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-2390
Practice Address - Country:US
Practice Address - Phone:702-340-3160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst