Provider Demographics
NPI:1619033222
Name:VILLAVICENCIO, DARLENE MARIE
Entity Type:Individual
Prefix:MRS
First Name:DARLENE
Middle Name:MARIE
Last Name:VILLAVICENCIO
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 1:3683 CHINO AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-4719
Mailing Address - Country:US
Mailing Address - Phone:909-628-1272
Mailing Address - Fax:
Practice Address - Street 1:3683 CHINO AVE
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-4719
Practice Address - Country:US
Practice Address - Phone:909-628-1272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health