Active NPI
Theo Villalobos, LMFT
- Mental Health Counselor
- San Diego, CA
National Provider Identifier
1063014785
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 122367
- Practice address
- 3298 Governor Dr Unit 22057
San Diego, CA 92192-5004 - Phone
- (408) 646-8813
- NPI assigned
- Nov 9, 2020
- Sex
- Unspecified or another gender identity
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 122367 | CA | Primary |
Addresses
Primary practice location
3298 Governor Dr Unit 22057
San Diego, CA 92192-5004
Mailing address
3298 Governor Dr Unit 22057
San Diego, CA 92192-5004
Phone (408) 646-8813
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 122367 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721606400000",
"number": "1063014785",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3298 GOVERNOR DR UNIT 22057",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921925004",
"telephone_number": "408-646-8813"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3298 GOVERNOR DR UNIT 22057",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921925004",
"telephone_number": "408-646-8813"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VILLALOBOS",
"first_name": "THEO",
"credential": "LMFT",
"sole_proprietor": "YES",
"sex": "X",
"enumeration_date": "2020-11-09",
"last_updated": "2024-07-22",
"certification_date": "2024-07-22",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "122367",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.