Provider Demographics
NPI:1831228824
Name:VILLAFANA, JOSE ELIAS (MFT)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:ELIAS
Last Name:VILLAFANA
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:MR
Other - First Name:ELIAS
Other - Middle Name:
Other - Last Name:VILLAFANA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:PO BOX 1156
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91946-1156
Mailing Address - Country:US
Mailing Address - Phone:619-540-0700
Mailing Address - Fax:619-462-1856
Practice Address - Street 1:8080 LA MESA BLVD STE 204
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-0362
Practice Address - Country:US
Practice Address - Phone:619-540-0700
Practice Address - Fax:619-462-1856
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 36841106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist