Provider Demographics
NPI:1598160129
Name:MIRNA VILLATORO
Entity Type:Organization
Organization Name:MIRNA VILLATORO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL HUGIENIST
Authorized Official - Prefix:
Authorized Official - First Name:MIRNA
Authorized Official - Middle Name:G
Authorized Official - Last Name:VILLATORO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-388-7233
Mailing Address - Street 1:11100 SEPULVEDA BLVD
Mailing Address - Street 2:#232
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1131
Mailing Address - Country:US
Mailing Address - Phone:818-388-3917
Mailing Address - Fax:
Practice Address - Street 1:15700 MINNEHAHA ST
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344
Practice Address - Country:US
Practice Address - Phone:818-388-3917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHAP 351320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness