Provider Demographics
NPI:1710597752
Name:VILLALVAZO, PRISCILLA M
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:M
Last Name:VILLALVAZO
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 1:10628 PICO VISTA RD
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-3055
Mailing Address - Country:US
Mailing Address - Phone:562-646-8678
Mailing Address - Fax:
Practice Address - Street 1:10628 PICO VISTA RD
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-3055
Practice Address - Country:US
Practice Address - Phone:562-646-8678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant