1093223901 NPI number — DANIEL M. VILLAROSA, M.D., A PROFESSIONAL CORPORATION

Table of content: (NPI 1093223901)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093223901 NPI number — DANIEL M. VILLAROSA, M.D., A PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DANIEL M. VILLAROSA, M.D., A PROFESSIONAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093223901
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18064 WIKA RD STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APPLE VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92307-2182
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-242-6652
Provider Business Mailing Address Fax Number:
760-242-6642

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18064 WIKA RD STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APPLE VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92307-2182
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-242-6652
Provider Business Practice Location Address Fax Number:
760-242-6642
Provider Enumeration Date:
01/12/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VILLAROSA
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
PHYSICIAN OWNER
Authorized Official Telephone Number:
909-322-3124

Provider Taxonomy Codes

  • Taxonomy code: 207VX0000X , with the licence number:  C50281 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)