Provider Demographics
NPI:1528543394
Name:JOHN A GOROSTIZA VILLANUEVA MD, INC
Entity Type:Organization
Organization Name:JOHN A GOROSTIZA VILLANUEVA MD, INC
Other - Org Name:JOHN A GOROSTIZA VILLANUEVA MD, INC PAIN & SPINE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DOCTOR AND OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN A
Authorized Official - Middle Name:GOROSTIZA
Authorized Official - Last Name:VILLANUEVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-437-3661
Mailing Address - Street 1:2121 W MAGNOLIA BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-1706
Mailing Address - Country:US
Mailing Address - Phone:626-437-3661
Mailing Address - Fax:818-626-3058
Practice Address - Street 1:2121 W MAGNOLIA BLVD STE B
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506
Practice Address - Country:US
Practice Address - Phone:818-939-9398
Practice Address - Fax:818-626-3058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-27
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty