Provider Demographics
NPI:1265486559
Name:DE VILLIERS, MARGARET GRACE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:GRACE
Last Name:DE VILLIERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 POLLARD RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1420
Mailing Address - Country:US
Mailing Address - Phone:408-374-1212
Mailing Address - Fax:408-374-4160
Practice Address - Street 1:812 POLLARD RD
Practice Address - Street 2:SUITE 1
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1420
Practice Address - Country:US
Practice Address - Phone:408-374-1212
Practice Address - Fax:408-374-4160
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42750208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0056110Medicaid
CAA42750OtherSTATE LICENSE NUMBER
CAA42750OtherSTATE LICENSE NUMBER
CAA42750OtherSTATE LICENSE NUMBER
CAF30693Medicare UPIN