Provider Demographics
NPI:1619535424
Name:VILLALOBOS, JENNIFER (SOCIAL WORKER)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:VILLALOBOS
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14045 OXNARD ST APT 221
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-3830
Mailing Address - Country:US
Mailing Address - Phone:818-294-8116
Mailing Address - Fax:
Practice Address - Street 1:5425 POMONA BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-1716
Practice Address - Country:US
Practice Address - Phone:323-728-0411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker