Provider Demographics
NPI:1679444715
Name:VILLAREAL, PAOLA SAMANTHA
Entity type:Individual
Prefix:
First Name:PAOLA
Middle Name:SAMANTHA
Last Name:VILLAREAL
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 1:15913 GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-5103
Mailing Address - Country:US
Mailing Address - Phone:562-328-5723
Mailing Address - Fax:
Practice Address - Street 1:15913 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-5103
Practice Address - Country:US
Practice Address - Phone:562-328-5723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-12
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3305040104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty