Provider Demographics
NPI:1376287334
Name:VILLALPANDO, LELAH SHARRA (PHD)
Entity Type:Individual
Prefix:DR
First Name:LELAH
Middle Name:SHARRA
Last Name:VILLALPANDO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11256 VOLLMER DR
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-4874
Mailing Address - Country:US
Mailing Address - Phone:909-746-6963
Mailing Address - Fax:
Practice Address - Street 1:851 S MOUNT VERNON AVE STE 7A
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3926
Practice Address - Country:US
Practice Address - Phone:760-241-6044
Practice Address - Fax:909-639-7079
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-26
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY34387103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist