Provider Demographics
NPI:1518919604
Name:ALEXANDER A VILLARASA, MD INCORPORATED
Entity Type:Organization
Organization Name:ALEXANDER A VILLARASA, MD INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:ALCANTRA
Authorized Official - Last Name:VILLARASA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-416-5010
Mailing Address - Street 1:1180 N INDIAN CANYON DR
Mailing Address - Street 2:SUITE W400
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4800
Mailing Address - Country:US
Mailing Address - Phone:760-416-5010
Mailing Address - Fax:760-416-5001
Practice Address - Street 1:1180 N INDIAN CANYON DR
Practice Address - Street 2:SUITE W400
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4800
Practice Address - Country:US
Practice Address - Phone:760-416-5010
Practice Address - Fax:760-416-5001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34432173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A344320Medicaid