Provider Demographics
NPI:1508128968
Name:VILLAGRAN, LUZ
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:
Last Name:VILLAGRAN
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 1:337 FOX LOOP
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-3819
Mailing Address - Country:US
Mailing Address - Phone:862-209-8284
Mailing Address - Fax:
Practice Address - Street 1:337 FOX LOOP
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-3819
Practice Address - Country:US
Practice Address - Phone:862-209-8284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist