Provider Demographics
NPI:1952653263
Name:VILLALOBOS, CRYSTAL MONIQUE
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:MONIQUE
Last Name:VILLALOBOS
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 1:8729 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047-3327
Mailing Address - Country:US
Mailing Address - Phone:323-535-6818
Mailing Address - Fax:323-750-9537
Practice Address - Street 1:8729 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-3327
Practice Address - Country:US
Practice Address - Phone:323-535-6818
Practice Address - Fax:323-750-9537
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)