Provider Demographics
NPI:1578666129
Name:VILLAROSA, DANIEL MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:MARK
Last Name:VILLAROSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18064 WIKA RD
Mailing Address - Street 2:STE102
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2125
Mailing Address - Country:US
Mailing Address - Phone:760-242-6652
Mailing Address - Fax:760-242-6642
Practice Address - Street 1:18064 WIKA RD
Practice Address - Street 2:STE102
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2125
Practice Address - Country:US
Practice Address - Phone:760-242-6652
Practice Address - Fax:760-242-6642
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50281174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C502811Medicaid
CA00C502811Medicaid
CA00C502810Medicare ID - Type UnspecifiedMEDICARE