1902007446 NPI number — BARBARA VILLA OD PC

Table of content: TARA MARIE FRENI LLMFT, LLPC (NPI 1942752589)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902007446 NPI number — BARBARA VILLA OD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BARBARA VILLA OD PC
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:
1902007446
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
28331 LA PLUMOSA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAGUNA NIGUEL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92677-7050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-400-1530
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2700 PARK AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUSTIN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92782
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-259-1530
Provider Business Practice Location Address Fax Number:
714-259-1532
Provider Enumeration Date:
05/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VILLA
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
JEAN
Authorized Official Title or Position:
PRINCIPAL OFFICER
Authorized Official Telephone Number:
949-400-1530

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OPT 10245 TPA , 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)





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