Provider Demographics
NPI:1043748437
Name:VILLARREAL, JULIA FAY
Entity type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:FAY
Last Name:VILLARREAL
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JULIA
Other - Middle Name:FAY
Other - Last Name:LIM-VILLARREAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7273 14TH AVE
Mailing Address - Street 2:#120B
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95820
Mailing Address - Country:US
Mailing Address - Phone:210-739-3247
Mailing Address - Fax:
Practice Address - Street 1:4470 W SUNSET BLVD STE 107
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6309
Practice Address - Country:US
Practice Address - Phone:916-919-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-30
Last Update Date:2024-10-02
Deactivation Date:2018-05-15
Deactivation Code:
Reactivation Date:2018-05-21
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 101YA0400X
CA107363106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)