Provider Demographics
NPI:1568777241
Name:VILLASENOR, MONIQUE (MS IMF)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:VILLASENOR
Suffix:
Gender:F
Credentials:MS IMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 BROADWAY
Mailing Address - Street 2:SUITE 207
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-2767
Mailing Address - Country:US
Mailing Address - Phone:619-425-5609
Mailing Address - Fax:619-425-8349
Practice Address - Street 1:7545 METROPOLITAN DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4402
Practice Address - Country:US
Practice Address - Phone:619-718-9890
Practice Address - Fax:619-718-9897
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAII5021314101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)