Provider Demographics
NPI:1457333700
Name:VILLARUZ, JERIC CANDA (MD)
Entity Type:Individual
Prefix:MR
First Name:JERIC
Middle Name:CANDA
Last Name:VILLARUZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 GREEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:FREEDOM
Mailing Address - State:CA
Mailing Address - Zip Code:95019-3139
Mailing Address - Country:US
Mailing Address - Phone:831-728-0440
Mailing Address - Fax:831-728-4293
Practice Address - Street 1:268 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:FREEDOM
Practice Address - State:CA
Practice Address - Zip Code:95019-3139
Practice Address - Country:US
Practice Address - Phone:831-728-0440
Practice Address - Fax:831-728-4293
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54496207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOA544960OtherBLUE SHIELD
CAOOA544960OtherBLUE SHIELD
CAF70520Medicare UPIN