Individual
CARISSA LEIGH VILLAVICENCIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
655 W AVENUE Q, PALMDALE, CA 93551-3894
(661) 259-5200
Mailing address
27898 SKYCREST CIR, VALENCIA, CA 91354-1415
(661) 904-0943
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
08/29/2018
Last updated
01/15/2020
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