Provider Demographics
NPI:1639500929
Name:ALEXANDER A VILLARASA MD
Entity Type:Organization
Organization Name:ALEXANDER A VILLARASA MD
Other - Org Name:DESERT VALLEY PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:ALCANTARA
Authorized Official - Last Name:VILLARASA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-327-5900
Mailing Address - Street 1:1801 E TAHQUITZ CANYON WAY
Mailing Address - Street 2:STE 102
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-7120
Mailing Address - Country:US
Mailing Address - Phone:760-327-5900
Mailing Address - Fax:760-327-5905
Practice Address - Street 1:1801 E TAHQUITZ CANYON WAY
Practice Address - Street 2:STE 102
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-7120
Practice Address - Country:US
Practice Address - Phone:760-327-5900
Practice Address - Fax:760-327-5905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34432208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A344320Medicaid