Provider Demographics
NPI:1104094895
Name:VILLEGAS GOMEZ, CYNTHIA JESUS
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:JESUS
Last Name:VILLEGAS GOMEZ
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 1:13223 ELMCROFT AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-2677
Mailing Address - Country:US
Mailing Address - Phone:562-405-4119
Mailing Address - Fax:
Practice Address - Street 1:1745 W ORANGEWOOD AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2004
Practice Address - Country:US
Practice Address - Phone:714-221-6400
Practice Address - Fax:714-221-6401
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator