Provider Demographics
NPI:1730751280
Name:VILLAGRANA, CYNTHIA MARISSA
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:MARISSA
Last Name:VILLAGRANA
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 1:11650 WOODCOCK AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-2517
Mailing Address - Country:US
Mailing Address - Phone:818-621-5716
Mailing Address - Fax:
Practice Address - Street 1:6931 VAN NUYS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3996
Practice Address - Country:US
Practice Address - Phone:818-989-9214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator