Provider Demographics
NPI:1710946009
Name:VILLAR, HERMILITO L
Entity Type:Individual
Prefix:
First Name:HERMILITO
Middle Name:L
Last Name:VILLAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14400 ROSCOE BLVD
Mailing Address - Street 2:SUITE #B
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-3001
Mailing Address - Country:US
Mailing Address - Phone:818-830-6888
Mailing Address - Fax:818-830-6891
Practice Address - Street 1:14400 ROSCOE BLVD
Practice Address - Street 2:SUITE #B
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-3001
Practice Address - Country:US
Practice Address - Phone:818-830-6888
Practice Address - Fax:818-830-6891
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41795207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0026280Medicaid
CAW10274Medicare ID - Type Unspecified
CAA85714Medicare UPIN