Provider Demographics
NPI:1942779863
Name:VILLANUEVA, MARINA ALEJANDRA
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:ALEJANDRA
Last Name:VILLANUEVA
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 1:200 S LOS ROBLES AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-5800
Mailing Address - Country:US
Mailing Address - Phone:818-256-5566
Mailing Address - Fax:
Practice Address - Street 1:200 S LOS ROBLES AVE STE 250
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-5800
Practice Address - Country:US
Practice Address - Phone:818-256-5566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-20
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA135135106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist