Provider Demographics
NPI:1538101860
Name:VILLAROSA, RAFAEL H (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:H
Last Name:VILLAROSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:16174 HERITAGE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-5220
Mailing Address - Country:US
Mailing Address - Phone:909-793-2226
Mailing Address - Fax:909-793-3336
Practice Address - Street 1:255 TERRACINA BLVD STE 207
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4870
Practice Address - Country:US
Practice Address - Phone:909-793-2226
Practice Address - Fax:909-793-3336
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC50463207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C504630Medicaid
CA110235736OtherRAILROAD
CA110235736OtherRAILROAD
CAF95727Medicare UPIN