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1053080564
IVAN VILLASENOR
PASADENA, CA
NPI
1053080564
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2021-09-08
Last Update Date
2021-09-08
Business Address
IVAN VILLASENOR
1230 N MARENGO AVE
PASADENA, CA 91103-2217
Phone number: 626-797-1124
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Mailing Address
IVAN VILLASENOR
2725 FAIR OAKS AVE
ALTADENA, CA 91001-4753
Phone number: 562-726-8193
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