Provider Demographics
NPI:1871095349
Name:VILLADA CABRERA, AMY
Entity type:Individual
Prefix:MISS
First Name:AMY
Middle Name:
Last Name:VILLADA CABRERA
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 1:138 BEAJOLAIS CT
Mailing Address - Street 2:
Mailing Address - City:LOS BANOS
Mailing Address - State:CA
Mailing Address - Zip Code:93635
Mailing Address - Country:US
Mailing Address - Phone:209-704-1259
Mailing Address - Fax:
Practice Address - Street 1:138 BEAJOLAIS CT
Practice Address - Street 2:
Practice Address - City:LOS BANOS
Practice Address - State:CA
Practice Address - Zip Code:93635
Practice Address - Country:US
Practice Address - Phone:209-704-1259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician