Provider Demographics
NPI:1285854398
Name:VILLALOBOS, CHRIS SOCORRO (CADC II)
Entity type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:SOCORRO
Last Name:VILLALOBOS
Suffix:
Gender:M
Credentials:CADC II
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2501 W EL SEGUNDO BLVD
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-3317
Mailing Address - Country:US
Mailing Address - Phone:323-754-2816
Mailing Address - Fax:323-754-2828
Practice Address - Street 1:2501 W EL SEGUNDO BLVD
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-3317
Practice Address - Country:US
Practice Address - Phone:323-754-2816
Practice Address - Fax:323-754-2828
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1989Medicaid