Provider Demographics
NPI:1144253568
Name:VILLELA, LEOPOLDO FELIX (PHD)
Entity type:Individual
Prefix:
First Name:LEOPOLDO
Middle Name:FELIX
Last Name:VILLELA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:LEOPOLDO
Other - Middle Name:F
Other - Last Name:VILLELA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2595 MISSION ST STE 211
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-2573
Mailing Address - Country:US
Mailing Address - Phone:415-641-7169
Mailing Address - Fax:415-641-0307
Practice Address - Street 1:2595 MISSION ST STE 211
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-2573
Practice Address - Country:US
Practice Address - Phone:415-641-7169
Practice Address - Fax:415-641-0307
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11333103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
943198718Medicare UPIN