Provider Demographics
NPI:1366243925
Name:VILLAGOMEZ, JENNIFER RACHEL
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:RACHEL
Last Name:VILLAGOMEZ
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 1:105 E VENTURA ST APT C
Mailing Address - Street 2:
Mailing Address - City:SANTA PAULA
Mailing Address - State:CA
Mailing Address - Zip Code:93060-2601
Mailing Address - Country:US
Mailing Address - Phone:805-501-3648
Mailing Address - Fax:
Practice Address - Street 1:105 E VENTURA ST APT C
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-2601
Practice Address - Country:US
Practice Address - Phone:805-501-3648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health