Provider Demographics
NPI:1407099203
Name:JOSE D VILLARICA, M.D, INC
Entity Type:Organization
Organization Name:JOSE D VILLARICA, M.D, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:D
Authorized Official - Last Name:VILLARICA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-208-8114
Mailing Address - Street 1:8227 OAK KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-9373
Mailing Address - Country:US
Mailing Address - Phone:916-208-8114
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL PLAZA DR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3037
Practice Address - Country:US
Practice Address - Phone:916-208-8114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-09
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA23438OtherUPIN
CA00A232270Medicare PIN