Individual
GENESEE MAYLEE VILLALTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1665 DOMINICAN WAY STE 224, SANTA CRUZ, CA 95065-1515
(415) 476-7988
(831) 331-4737
Mailing address
427 DARWIN ST # B, SANTA CRUZ, CA 95062-2628
(707) 360-8184
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
—
—
363AM0700X
Medical Physician Assistant
Primary
PA61474
CA
Other
Enumeration date
06/30/2022
Last updated
06/18/2025
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