Provider Demographics
NPI:1073695250
Name:VILLALON, JANETTE CARBONE (PA-C)
Entity Type:Individual
Prefix:
First Name:JANETTE
Middle Name:CARBONE
Last Name:VILLALON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JANETTE
Other - Middle Name:AUDREY
Other - Last Name:CARBONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICIAN ASSISTANT
Mailing Address - Street 1:101 THE CITY DRIVE, BLGD 22 C FIRST FLOOR
Mailing Address - Street 2:UCI-
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-0708
Mailing Address - Country:US
Mailing Address - Phone:714-456-8313
Mailing Address - Fax:
Practice Address - Street 1:101 THE CITY DR S BLDG 22C1
Practice Address - Street 2:UCI MEDICAL CENTER
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3201
Practice Address - Country:US
Practice Address - Phone:714-456-8313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00000PA16584363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPA16584AMedicare PIN