Active NPI
Samantha Mariah Villa
- Behavior Technician
- Lake Elsinore, CA
National Provider Identifier
1528733540
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- Y8170769
- Practice address
- 41097 Hightower St
Lake Elsinore, CA 92532-1649 - Phone
- (714) 853-3726
- NPI assigned
- Aug 11, 2021
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Y8170769 | CA | Primary |
Addresses
Primary practice location
41097 Hightower St
Lake Elsinore, CA 92532-1649
Mailing address
41097 Hightower St
Lake Elsinore, CA 92532-1649
Phone (714) 853-3726
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 |
|---|---|---|---|
| Y8170769 | CA | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1628640000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1628640000000",
"number": "1528733540",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "41097 HIGHTOWER ST",
"city": "LAKE ELSINORE",
"state": "CA",
"postal_code": "925321649",
"telephone_number": "714-853-3726"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "41097 HIGHTOWER ST",
"city": "LAKE ELSINORE",
"state": "CA",
"postal_code": "925321649",
"telephone_number": "714-853-3726"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VILLA",
"first_name": "SAMANTHA",
"middle_name": "MARIAH",
"name_prefix": "Miss",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-08-11",
"last_updated": "2021-08-11",
"certification_date": "2021-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "CA",
"license": "Y8170769",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Elsinore, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.