Provider Demographics
NPI:1497898522
Name:VILLARUZ JR, TANACIO A (MD)
Entity Type:Individual
Prefix:DR
First Name:TANACIO
Middle Name:A
Last Name:VILLARUZ JR
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 1:2015 W 1ST ST STE K
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92703-3516
Mailing Address - Country:US
Mailing Address - Phone:714-547-7745
Mailing Address - Fax:
Practice Address - Street 1:2015 W 1ST ST STE K
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-3516
Practice Address - Country:US
Practice Address - Phone:714-547-7745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36175207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A361750Medicaid
CAGR0063230Medicaid
CAGR0063230Medicaid