Edgar Antonio Villa, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

61051 Issued in CA

Practice address

400 E. la Habra Blvd
La Habra
Cerritos, CA 90703-2640

Phone

(562) 691-3263

NPI assigned

Jul 5, 2011

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Divine Rehabilitation, Education, & Housing Network

  • Substance Abuse Rehabilitation Facility
  • Whittier, CA
  • NPI 1871903179
  NPD Authorized official
• Divine Treatment Centers

  • Substance Use Disorder Rehabilitation Clinic/Center
  • La Habra, CA
  • NPI 1396289401
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1309824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481587200000",
    "number": "1053608570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 E LA HABRA BLVD",
            "city": "LA HABRA",
            "state": "CA",
            "postal_code": "906315525",
            "telephone_number": "714-589-9228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 E. LA HABRA BLVD",
            "address_2": "LA HABRA",
            "city": "CERRITOS",
            "state": "CA",
            "postal_code": "907032640",
            "telephone_number": "562-691-3263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VILLA",
        "first_name": "EDGAR",
        "middle_name": "ANTONIO",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-07-05",
        "last_updated": "2016-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "28065",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "61051",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maria Vera
• Noemi Vera
• Keith Hardrick Vielle, SUDCC 6465
• Villa Celerina
• Blanca Villa
• Kenya Villacorta, BS
• Thea Villanueva, NP
• Cindy Villaverde
• Ramon Barachina Villegas III, O.D.
• Riana Camille Villegas

• Clinical Social Worker in Cerritos, CA
• Providers in Cerritos, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.