Provider Demographics
NPI:1700692555
Name:VILLALOBOS, MIA SAVANA
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:SAVANA
Last Name:VILLALOBOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67785 PEINETA RD
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-5580
Mailing Address - Country:US
Mailing Address - Phone:760-229-8849
Mailing Address - Fax:
Practice Address - Street 1:82380 MILES AVE
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-2608
Practice Address - Country:US
Practice Address - Phone:800-207-0272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician