Individual
JESSICA VILLANUEVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5628 E SLAUSON AVE, COMMERCE, CA 90040-2922
(818) 277-0157
Mailing address
5628 E SLAUSON AVE, COMMERCE, CA 90040-2922
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
172V00000X
Community Health Worker
—
—
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
95-2633765
MEDI-CAL
CA
Enumeration date
10/05/2021
Last updated
06/03/2025
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