Provider Demographics
NPI:1659020360
Name:VILLALOBOS, JESSICA ANN (ASW)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:ANN
Last Name:VILLALOBOS
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5284 ADOLFO RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-6790
Mailing Address - Country:US
Mailing Address - Phone:805-289-0120
Mailing Address - Fax:805-289-0130
Practice Address - Street 1:5284 ADOLFO RD STE 100
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-6790
Practice Address - Country:US
Practice Address - Phone:805-289-0120
Practice Address - Fax:805-289-0130
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW1052681041C0700X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA56CCOtherASPIRA