Provider Demographics
NPI:1396100442
Name:VELLA, SYLVIA (PSYD)
Entity type:Individual
Prefix:
First Name:SYLVIA
Middle Name:
Last Name:VELLA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2065 AVIATA RD
Mailing Address - Street 2:UNIT 61
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-0413
Mailing Address - Country:US
Mailing Address - Phone:619-952-9835
Mailing Address - Fax:
Practice Address - Street 1:1455 FRAZEE RD
Practice Address - Street 2:SUITE 500
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4301
Practice Address - Country:US
Practice Address - Phone:619-952-9835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-16
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84380101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional