Provider Demographics
NPI:1275172769
Name:VILLEGAS, EDWARD JOSEPH FLORES
Entity Type:Individual
Prefix:
First Name:EDWARD JOSEPH
Middle Name:FLORES
Last Name:VILLEGAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 BRUNSWICK ST
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94014-1202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1550 TREAT AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-5234
Practice Address - Country:US
Practice Address - Phone:415-641-8000
Practice Address - Fax:415-641-8002
Is Sole Proprietor?:No
Enumeration Date:2019-12-31
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246YR1600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health InformationRegistered Record Administrator