Provider Demographics
NPI:1609223718
Name:VILLA HEALTH CENTER LLC
Entity Type:Organization
Organization Name:VILLA HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:EMANUEL
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-782-9216
Mailing Address - Street 1:304 N VILLA ST
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3211
Mailing Address - Country:US
Mailing Address - Phone:559-782-9216
Mailing Address - Fax:559-782-9212
Practice Address - Street 1:304 N VILLA ST
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3211
Practice Address - Country:US
Practice Address - Phone:559-782-9216
Practice Address - Fax:559-782-9212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-18
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG62334208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG62334Medicare Oscar/Certification