Provider Demographics
NPI:1649768235
Name:VILLEGAS, LIZBETH (SA-C)
Entity Type:Individual
Prefix:
First Name:LIZBETH
Middle Name:
Last Name:VILLEGAS
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 VIRGINIA AVE APT 111
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-5187
Mailing Address - Country:US
Mailing Address - Phone:310-403-6376
Mailing Address - Fax:
Practice Address - Street 1:2401 VIRGINIA AVE APT 111
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-5187
Practice Address - Country:US
Practice Address - Phone:310-403-6376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-29
Last Update Date:2018-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17-693246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant