Provider Demographics
NPI:1861785636
Name:CLIMO, ALMA VILLANUEVA CUSTODIO (MT)
Entity type:Individual
Prefix:
First Name:ALMA
Middle Name:VILLANUEVA CUSTODIO
Last Name:CLIMO
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 1ST AVE STE 240
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-2382
Mailing Address - Country:US
Mailing Address - Phone:619-288-5825
Mailing Address - Fax:
Practice Address - Street 1:3384 LLOYD ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-6038
Practice Address - Country:US
Practice Address - Phone:619-288-5825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1999-004174172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker