Provider Demographics
NPI:1093060634
Name:ALEXANDER VILLICANA MD APC
Entity Type:Organization
Organization Name:ALEXANDER VILLICANA MD APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLICANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-447-6641
Mailing Address - Street 1:624 W DUARTE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7603
Mailing Address - Country:US
Mailing Address - Phone:626-447-6641
Mailing Address - Fax:626-796-6936
Practice Address - Street 1:624 W DUARTE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7603
Practice Address - Country:US
Practice Address - Phone:626-447-6641
Practice Address - Fax:626-796-6936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA21627208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA22691Medicare UPIN
CAA21627Medicare PIN